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RC117.F6M53         The  house-fly  at  the 


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THE  HOUSE-FLY  AT  THE  BAR 

INDICTMENT 

GUILTY  OR  NOT  GUILTY? 


EVIDENCE  : —     IN  THE  MATTER  OF  THE  PEOPLE 

against 
THE  COMMON  HOUSE  FLY 


APRIL,  1909 
THE  MERCHANTS'  ASSOQATION  OF  NEW  YORK 


THE  HOUSE-FLY  AT  THE  BAR 

INDICTMENT 

GUILTY  OR  NOT  GUILTY? 


EVIDENCE  : IN  THE  MATTER  OF  THE  PEOPLE 

against 
THE  COMMON  HOUSE  FLY 


APRIL,  1909 
THE  MERCHANTS'  ASSOQATION  OF  NEW  YORK 


THE     MERCHANTS'    ASSOCIATION     OF    NEW   YORK 


OFFICERS 

HENRY  R.  TOWNE,   President 
GUSTAV  H.  SCHWAB,  ist  Vice-Pres.  GUSTAV  VINTSCHGER,  Treasurer 

WM.   A.  MARBLE,  2d  Vice-Pres.  S.   C.   MEAD,   Secretary 

ROBERT  C.  OGDEN,  3d  Vice-Pres.  FREDERICK  B.  DeBERARD,   Statistician 

JOHN  W.  GRIGGS,  Counsel 


DIRECTORS 

Nathan    Bijxni 32  Nassau  St 

Frank   R.   Chambers    Rogers,  Peet  &  Co.,  Broadway  and  13th  St 

J.    Hampden    Dougherty 27   William   St 

Habry  Dowie   De  Winter  &  Co.,  334  Greenwich  St. 

Thomas  H.  Downing   R.  F.  Downing  &  Co.,  24  State  St. 

Prof.  Joseph  French  Johnson,  Dean,  School  of  Commerce.   Finance   and   Accounts,   New 

York  University   32  Waverley   Place 

Walter  C.  Rerr Pres.  Westinghouse,  Church,  Kerr  &  Co.,  10  Bridge  St 

James    H.    Killough J.  H.  Killough  &  Co.,  157  West  St 

Charles  R.  Lamb J.  &  R.  Lamb,  23  Sixth  Ave. 

Wm.  H.  McCord Post  &  McCord,  44.  East  23d  St 

J.    Crawford    McCreery The  James  McCreery  Realty  Corp.,  112  W.  42d  St 

Wm.   a.   Marble Vice-Pres.    R.    &   G.    Corset   Co.,   39s    Broadway 

Marcus   M.    Marks David  Marks  &  Sons,  687  Broadway 

Daniel   P.   Morse President  Morse  &  Rogers,  134  Duane  St 

Root.   C.   Ocden 125  E.  56th  St 

Albert    Plaut    Lehn  &  Fink,  120  William  St 

Edwin   H.   Sayre    R.  C.  Williams  &  Co.,  56  Hudson  St 

GusTAV  H.   Schwab Oelrichs  &  Co.,  s  Broadway 

Henry  R.  Towne President  Yale  &  Towne  Mfg.  Co.,  9  Murray  St 

George  Fred'k  Vietor Vietor  &  Achelis,  66  Leonard  St 

GusTAV  Vintschger   President  Markt  &  Co.,  Ltd.,  194  West  St 

Silas    D.    Webb President  China  &  Japan  Trading  Co.,  32  Burling  Slip 

Clarence  Whitman  Clarence  Whitman  &  Co.,  39  Leonard  St 

F.  W.   Wool  worth   President  Guardian  Trust  Co.,  170  Broadway 


COMMITTEE  ON 
POLLUTION  OF  THE  WATERS  OF  NEW  YORK 

EDWARD  HATCH,  Jr.,  Chairman 
J.   PIERPONT   MORGAN  JOHN  Y.  CULYER,  C.  E. 

ALBERT  VANDER  VEER,  M.  D.  DANIEL  D.  JACKSON,  S.  B. 


BY  WAY  OF  EXPLANATION 

IN  DECEMBER,  1907,  this  Association  published  the  report  made  to  it 
by  Daniel  D.  Jackson  on  the  "Pollution  of  New  York  Harbor  as  a 
Menace  to  Health  by  the  Dissemination  of  Intestinal  Diseases 
Through  the  Agency  of  the  Common  House-Fly,"  in  which  he  proved 
beyond  a  doubt  that  raw  sewage  discharged  into  large  or  small  bodies  of 
water,  even  if  such  water  was  not  used  for  drinking  purposes,  furnished  feed- 
ing grounds  for  flies,  from  which  they  gathered  and  spread  the  germs  of  typhoid 
fever  and  other  intestinal  diseases. 

In  cities  whose  sewers  empty  into  lakes,  tidal  waters  or  slow-moving 
streams,  deposits  of  filth  are  certain  to  collect  on  the  banks  or  beaches,  and  house- 
flies  are  as  certain  to  seek  them  out  and  to  carry  the  disease  germs  from  the 
sewage-polluted  water-front  inland  to  the  homes  of  the  inhabitants.  Thus  it 
will  be  seen  that  water-front  conditions,  similar  to  those  which  afflict  New  York, 
are  to  be  found  in  many  other  cities,  and  that  they,  too,  must  grapple  with  the 
problem  of  protecting  the  health  of  their  inhabitants  from  the  closely  associated 
pests  of  flies  and  untreated  sewage. 

So  much  interest  was  aroused  by  the  publication  of  this  report  that  the 
Association's  Committee  on  Water  Pollution  has  been  encouraged  to  pursue  its 
investigations  of  the  habits  of  this  pest,  which  Dr.  L.  O.  Howard,  Chief  Ento- 
mologist of  the  Department  of  Agriculture,  has  re-christened  the  "typhoid  fly" 
— and  to  assemble  the  testimony  of  the  health  officers  and  other  expert  sanitarians 
of  the  country  as  to  the  dangers  arising  from  this  cause  and  the  means  which 
may  be  taken  to  combat  them. 

With  this  end  in  view  the  Chairman  of  the  Committee  addressed  the  fol- 
lowing letter  to  health  officers,  physicians  and  other  authorities  throughout  the 
United  States  and  Canada : 

Dear  Sir: 

Will  you  be  so  kind  as  to  inform  us  whether  your  department  has  been 
making  any  investigations  with  regard  to  transmission  of  typhoid  and  other  germ 
diseases  through  the  medium  of  flies  ? 

You  are  probably  acquainted  with  the  report  made  by  Dr.  Jackson,  of  this 
committee,  on  the  dangerous  activity  of  the  common  house-fly,  and  will  under- 
stand our  desire  to  have  the  benefit  of  your  observations  on  the  very  important 
subject  of  disease  transmission  by  flies. 

Incidentally,  we  shall  be  glad  to  know  what  is  your  opinion  as  to  the  trans- 
mission of  typhoid  bacilli  through  impure  milk  and  polluted  water  supply.  We 
ask  this  question  because  some  authorities  have  recently  made  the  statement  that 

6 


typhoid  infection  from  these  causes  is  insignificant  as  compared  with  that  through 
the  medium  of  flies. 

We  are  gathering  this  information  from  all  parts  of  the  United  States, 
and  shall  be  pleased  to  send  you  a  memorandum  of  the  result  when  completed. 

Yours  truly, 

Edwakd  Hatch,  Jr.,  Chairman. 

The  result  of  the  correspondence  which  ensued  is  embodied  in  the  pages 
which  follow.  It  is  believed  that  the  perusal  of  these  letters  and  the  extracts 
from  the  scientific  monographs  here  presented  will  serve  to  convince  those  who 
may  have  hitherto  given  little  thought  to  the  subject  that  the  common  house-fly 
is  one  of  the  most  dangerous  pests  in  the  world,  and  to  stir  all  who  read  this 
little  book  to  take  an  active  part  in  the  campaign  for  the  extermination  of  flies  by 
the  removal  of  conditions  which  breed  them. 

Edwaed  Hatch,  Jr.,  Chairman. 

J.  PiERPONT  Morgan. 

John  Y.  Culyer,  C.  E. 

Albert  Vander  Veer,  M.  D. 

Daniel  D.  Jackson,  S.  B. 

Committee  on  Pollution  of  State  Waters, 
The  Merchants'  Association  of  New 
York. 


WHAT  HEALTH    AUTHORITIES   SAY    ABOUT 
THE  HOUSE-FLY. 


Extracts    from    Letters    Discussing  its   Agency    in    Spreading 

Typhoid  Fever  and  Other  Intestinal  Diseases  Received 

by  the    Committee    on  Water   Pollution  from  All 

Parts  of  the  Country. 


While  health  authorities  naturally  hold  varying  views  as  to  the  relative 
influence  of  flies,  polluted  water  and  impure  milk  in  the  transmission  of  typhoid 
fever,  there  is  practically  no  dispute  of  the  assertion  that  flies  do  carry  and  dis- 
seminate the  germs  of  the  disease.  The  great  importance  attached  to  their  agency 
as  spreaders  of  typhoid  and  other  germs  by  the  majority  of  the  correspondents 
who  have  answered  the  inquiries  of  the  Committee  is  sufficient  warrant  for  the 
publication  of  the  letters  which  are  here  quoted. 

FROM   DR.  G.  W.  COLER,  HEALTH   OFFICER,  ROCHESTER,  N.  Y. 

My  Annual  Report  for  1906  contains  the  following  reference  to  the 
house-fly : 

"They  not  only  become  nuisances,  but  they  are  to  a  large  extent  carriers 
of  disease.  They  fly  from  the  polluted  places  in  which  they  breed  to  the  faces, 
mouths  and  noses  of  sleeping  infants,  and  from  thence  to  men,  women  and 
children.  By  these  means  they  become  the  undoubted  carriers  of  disease.  Were 
it  possible  to  cause  all  the  manure  piles  to  be  properly  cared  for  by  covers  and 
screens,  it  would  not  only  rid  the  city  of  a  pest,  but  prevent,  to  a  considerable 
extent,  the  carrying  of  disease.  In  the  near  future  one  of  the  new  departments 
of  the  newer  medical  science  will  busy  itself  with  the  removing  of  the  manttre 
heap,  the  house-fly,  and  other  insect  pests." 

Rochester,  N.  Y.,  Nov.  7,  1908. 

FROM  J.  N.  HURTY,   SECRETARY  OF  THE  INDIANA  STATE  BOARD 
OF  HEALTH. 

We  have  records  of  several  instances  where  typhoid  fever  was  unques- 
tionably transmitted  by  flies.  The  last  instance  was  at  the  Wehrnely  Orphans' 
Home,  near  Richmond,  Ind.  Sewage  disposal  at  this  Home  is  by  the  use  of  a 
dilapidated  outhouse,  or  vault.  The  house  is  not  fly-proof,  and  it  was  un- 
doubtedly through  flies  that  the  typhoid  epidemic  was  started.  A  man  who  had 
recently  lost  his  wife  came  to  the  Home,  bringing  his  child  to  be  taken  care  of 
there.  He  was  sick  at  the  time  and  returned  to  die  two  weeks  afterward,  with 
typhoid  fever.  Within  eighteen  days  after  his  visit  typhoid  fever  broke  out  in 
the  Home,  one  death  and  fourteen  cases  resulting.  He  used  the  outhouse,  and 
there  was  no  possibility  of  drainage  getting  into  the  well.  Flies  must  have  car- 
ried the  infection.     That  typhoid  fever  may  be  transmitted  through  impure  milk 

7 


and  polluted  water  supply  is  beyond  question.  However,  my  observations  lead 
me  to  believe  that  ver>'  rarely  is  the  infection  carried  by  impure  milk,  but  quite 
frequently  in  polluted  water.  Much  of  our  data  leads  me  to  believe  that  it  is 
more  frequently  carried  by  flies  than  in  other  ways. 

Indianapolis,  Ind.,  Nov.  2,  1908. 

THE  SECRETARY  OF  THE  KANSAS  HEALTH  BOARD,  DR.  S.  J. 
CRUMBINE,  SAYS: 

A  year  ago  this  department  undertook  to  make  an  investigation  of  the 
cause  of  typhoid  fever  that  prevailed  to  an  alarming  extent  in  quite  a  number  of 
the  smaller  towns  in  the  western  part  of  this  State.  The  investigation  was  made 
by  Prof.  W.  C.  Hoad,  civil  and  sanitary  engineer  for  the  State  Board  of  Health, 
and  the  writer.  Among  the  five  towns  thus  visited  it  was  determined  that  in  no 
case  was  the  typhoid  epidemic  due  to  the  city  water  supply.  In  three  of  the 
cities  visited  we  came  to  the  conclusion  that  the  disease  was  spread  by  flies. 
In  each  town  the  cases  seemed  to  be  in  groups  in  certain  portions  of  the  city.  That 
is  to  say,  an  initial  case  would  start,  and  then,  immediately  surrounding  this 
case,  other  cases  would  come  down  with  the  disease.  There  was  no  common  milk 
or  water  supply  in  these  three  small  towns,  the  first  case  being  usually  an  im- 
ported one  into  the  town  from  some  other  point,  and  then  came  the  spread  of  the 
infection  by  the  common  house-fly.  We  invariably  found  a  filthy  condition  of 
sterilization  of  the  discharges  and  open  privy  vaults  to  which  the  fly  had  ready 
access,  many  of  the  houses  using  no  screens  whatever.  Thus  it  was  reasonable 
to  conclude  that  the  medium  of  dissemination  was  that  of  the  fly.  It  was  noted 
that  the  disease  continued  until  the  death  of  the  fly  by  the  advent  of  cold  weather. 
This  condition  has  prevailed  in  a  number  of  the  western  towns  in  the  State  during 
the  past  year,  and  in  the  absence  of  the  common  milk  and  water  supply,  there 
seems  to  be  no  other  conclusion  than  that  the  disease  is  spread  through  the  infec- 
tion of  food  by  the  fly  and  by  personal  contact  between  the  sick  and  the  well. 

Topeka,  Kan.,  Nov.  9,  1908. 

THE  "TYPHOID  FLY"  IN  THE  GREEN   MOUNTAINS. 

Several  cases  of  typhoid  infection  through  the  agency  of  flies  are  reported 
by  Dr.  Henry  D.  Holton,  of  Brattleboro,  Vt.,  Secretary  of  the  Vermont  State 
Board  of  Health :  For  several  years  one  or  more  persons  living  on  a  large  farm, 
which  received  its  water  supply  from  mountain  springs,  had  typhoid  fever  in  the 
autumn — new  farm  hands  generally  being  the  sufferers.  No  pollution  of  the 
water  supply  was  discovered,  but  investigation  showed  that  the  farm  privy  was 
unscreened  and  swarming  with  flies,  which  had  free  access  to  the  house  and  its 
food  supplies.  After  the  old  closet  was  abandoned  for  more  modern  arrange- 
ments, and  the  house  supplied  with  screens,  no  cases  of  typhoid  occurred  in  the 
neighborhood.  The  daughter  of  another  farmer  in  a  section  in  which  there  had 
been  no  typhoid  fever  for  many  years  came  home  when  she  developed  a  mild  case 
of  the  disease.  Two  other  children  were  stricken,  and  one  died.  Water  condi- 
tions were  found  to  be  unobjectionable,  but  it  was  learned  that  the  discharges 
from  the  patients  had  been  thrown  into  a  meadow  opposite  the  house,  which  had 
no  screens.  Flies  swarmed  upon  the  table  at  meal  time.  "To  my  mind,"  says 
Dr.  Holton,  "undoubtedly  the  disease  was  communicated  by  the  flies,  all  other 
sources  of  infection  being  excluded." 


MOST  OF  ATLANTA'S  TYPHOID  FROM   FLIES. 

This  department  has  made  some  investigations  of  the  flies  in  this  city; 
and  in  every  instance  we  found  the  feet  of  the  flies  carrying  colon  organisms,  and 
we  have  been  endeavoring  to  have  an  ordinance  passed  by  which  to  eliminate  the 
common  house-fly.  We  have  been  convinced  for  some  time  that  the  greater  part 
of  our  typhoid  fever  comes  more  from  the  activity  of  the  common  house-fly  than 
from  any  other  source.  Our  records  in  the  health  office  show  that  typhoid  fever 
comes  and  goes  with  the  house-fly,  while  other  conditions  appear  to  be  the  same. 

Claude  M.  Smith,  M.  D., 
Atlanta,  Ga.,  Nov.  5,  1908.  Director  of  Laboratory  of  Hygiene. 

TESTIMONY   FROM    LOUISIANA. 

There  can  be  no  doubt  that  under  certain  conditions  the  house-fly  is  a 
greater  element  of  danger  than  either  the  supply  of  impure  milk  or  polluted 
water,  or  both.  In  large  cities  where  the  entire  population  is  totally  dependent 
for  its  milk  supply  upon  the  cunning  and  unscrupulous  milkman,  the  danger  from 
the  adulteration  of  the  product  with  impure  water  can  scarcely  be  overestimated, 
and  probably  surpasses  that  due  to  the  house-fly.  I  feel  assured  that  when  you 
have  gathered  your  information  from  so  many  sources  all  over  the  country,  as 
you  propose  doing,  the  result  of  your  work  will  be  most  valuable  as  a  matter  of 
record. 

J.  A.  ESTOPINAL, 

Baton  Rouge,  La.,  Nov.  6,  1908.  Secretary  State  Board  of  Health. 

SECRETARY  HUGH  L.  TAYLOR,  OF  THE  COLORADO  STATE 
BOARD  OF  HEALTH,  SAYS: 

In  the  city  of  Denver  we  had  a  very  sad  as  well  as  plain  demonstration 
of  the  transmission  of  typhoid  fever  by  flies  and  milk.  Early  in  August  of  this 
year  the  wife  of  a  dairyman  was  taken  with  typhoid  fever,  remaining  at  home 
about  three  weeks  before  her  removal  to  the  hospital,  August  28th.  During  the 
first  two  weeks  in  September  we  received  reports  of  numerous  cases  of  typhoid 
fever  in  the  northern  portion  of  Denver,  and  upon  investigation  found  that  all 
of  these  cases  had  been  securing  their  milk  from  this  dairy.  An  inspection  of 
the  dairy  was  then  made,  and  in  addition  to  learning  of  the  illness  of  the  dairy- 
man's wife,  we  also  found  the  dairyman  himself  suflfering  with  a  mild  case  of 
typhoid  fever,  but  still  up  and  delivering  milk.  The  water  supply  of  this  dairy 
was  fairly  good.  However,  we  found  that  tlie  stools  of  both  the  wife  and  husband 
had  been  deposited  in  an  open  privy  vault  located  thirty-five  feet  from  the  milk- 
house,  which  was  unscreened  and  open  to  flies.  The  gelatine  culture  exposed 
for  thirty  minutes  in  the  rear  of  the  privy  vault  and  in  tlie  milk-house  among 
the  milk-cans  gave  numerous  colonies  of  typhoid  bacilli,  as  well  as  colon  bacilli 
and  the  ordinary  germ  life.  The  source  of  infection  in  the  dairyman's  wife's  case 
is  unknown,  but  I  am  positive  that  in  all  the  cases  that  occurred  on  this  milk  route 
the  infection  was  due  to  bacilli  carried  from  this  vault  by  flies  and  deposited  upon 
the  milk-cans,  separator  and  utensils  in  the  milk-house,  thereby  contaminating  the 
milk.  This  dairyman  supplied  milk  to  143  customers.  Fifty-five  cases  of  typhoid 
fever  occurred,  and  six  deaths  resulted  therefrom. 

This  epidemic  was  given  wide  publicity  by  our  local  papers  and  has  been 
a  vivid  object-lesson  to  the  people  of  Denver.     Our  Board  for  some  time  has 

9 


been  endeavoring  to  educate  the  public  and  the  merchants  to  the  fact  that  a  great 
many  cases  of  tuberculosis,  typhoid  fever  and  kindred  diseases  are  undoubtedly 
transmitted  through  the  medium  of  flies.  We  have  been  pounding  away  all  sum- 
mer endeavoring  to  stop  the  exposure  of  foods  and  vegetables  in  unscreened  con- 
dition in  front  of  stores,  and  while  we  have  not  been  completely  successful,  we 
have  made  a  good  start  and  through  the  public  press  we  have  carried  on  a  cam- 
paign of  education. 

In  closing  I  will  say  that  I  quite  agree  with  the  opinion  of  those  authorities 
who  maintain  that  the  fly  is  one  of  the  most  common  disseminators  of  typhoid 
infection.  I  think  that  one  of  the  most  important  works  for  health  authorities 
and  sanitarians  at  present  is  to  educate  the  public  to  the  danger  from  flies. 

Denver,  Nov.  7,  1908. 

FROM    H.    M.    BRACKEN,    EXECUTIVE    OFFICER,    MINNESOTA 
STATE  BOARD  OF  HEALTH. 

Several  years  ago,  during  the  collection  of  troops  for  the  Spanish-Ameri- 
can War,  an  epidemic  of  typhoid  fever  broke  out  in  one  of  the  camps  in  this 
State,  and  in  that  instance  the  study  was  carefully  carried  on  until  the  final  con- 
clusion was  reached  that  the  general  infection  was  through  flies.  This  report 
was  sent  in  to  the  Surgeon-General  of  the  Army  at  Washington.  We  fully  recog- 
nize this  possibility,  as  shown  by  our  regulation  relating  to  the  construction  of 
cesspools  and  vaults.  Regulation  123  reads  as  follows:  "All  human  excreta 
in  cities  and  villages  shall  be  deposited  in  sewers,  cesspools  or  vaults.  The  cess- 
pools or  vaults  must  be  made  water-tight  and  fly-proof." 

St.  Paul,  Minn.,  Nov.  11,  1908. 

FLY-BORNE  TYPHOID   IN   SOUTH   DAKOTA. 

I  have  just  investigated  a  specific  case  in  which  a  small  epidemic  of  typhoid 
fever  was  undoubtedly  caused  from  infection  being  carried  by  the  common 
house-fly.  The  case  was  something  like  this:  In  a  town  of  1,500  population,  with  a 
sewer  emptying  into  a  neighboring  stream,  we  had  an  unusual  period  of  drouth, 
the  stream  becoming  very  low  and  the  sewage  emptying  above  the  water  level. 
This  left  a  polluted  cesspool  accessible  to  flies  and  other  vermin.  About  a  dozen 
cases  broke  out  in  the  immediate  vicinity  of  this,  the  rest  of  the  city  being  en- 
tirely free  from  it.  The  epidemic  stopped  as  soon  as  the  frost  came  and  killed 
the  flies.  I  believe  that  more  cases  of  typhoid  fever  are  caused  by  flies  than  by 
any  other  source  of  infection.  They  carry  the  germs  and  plant  them  in  good 
culture  media,  such  as  milk,  vegetables  and  other  food  products. 

J.  Grassick,  M.  D., 
Grand  Forks,  N.  D.,  Nov.  16,  1908.  Secretary  State  Board  of  Health. 

A  TYPHOID  OUTBREAK   DUE  TO   CONTAMINATED   MILK. 

Several  years  ago  there  occurred  a  small  outbreak  of  typhoid  fever  of 
about  a  dozen  cases.  Each  family  aflfected  derived  its  milk  supply  from  the 
same  dairy.  There  was  no  other  common  probable  source  of  infection.  In- 
vestigation of  the  dairy  disclosed  conditions  which  could  very  well  have  pro- 
duced the  infection,  and  the  then  acting  health  officer  attributed  the  outbreak 
to  contaminated  milk.     We  exclude  from  the  city  the  product  of  any  dairy  on 

10 


the  premises  of  which  there  is  t>-phoid  fever  and  continue  the  exclusion  of  the 
product  until  all  conditions  which  might  favor  the  transmission  of  the  disease 
are  removed.  We  are  also  quite  convinced  that  contaminated  water  is  of  the 
utmost  etiologic  importance  in  regard  to  this  disease. 

David  J.  Levy,  M.  D., 
Kalamazoo,  Mich.,  Nov.  19,  1908.  Health  Officer. 

AGAINST  THE  THEORY  OF  FLY  EPIDEMICS. 
We  have  studied  the  question  of  transmission  of  typhoid  fever  by  flies 
to  some  extent,  and  are  of  the  opinion  that  flies  are  common  carriers  of  typhoid 
fever;  especially  is  this  true  of  isolated  cases.  However,  we  do  not  believe  that 
flies  cause  epidemics  of  typhoid  fever.  Where  we  find  a  number  of  cases  in  a 
locality  we  are  convinced  that  the  water  or  milk  is  affected. 

T.  D.  TuTTLE,  M.  D., 
Helena,  Mont.,  Nov.  6,  1908.        Secretary  State  Department  of  Public  Health. 

FLIES  SPREAD  TYPHOID  WITHIN   AN    INFECTED   HOUSE. 

Generally  speaking,  neighborhood  typhoid  (local  epidemics)  is  due  to 
milk  and  flies.  If  a  considerable  number  of  cases  develop  in  a  given  vicinity, 
it  is  our  policy  to  devote  especial  attention  to  the  milk  supply  of  that  vicinity. 
During  the  past  year  I  should  say  that  we  have  had  definite  proof  of  the  milk 
origin  of  about  six  such  small  local  epidemics.  The  typhoid  that  spreads  within 
a  house  from  one  member  of  a  family  to  another,  or  from  one  occupant  of  a 
house  to  others,  we  believe  to  be  due  to  flies  and  fingers. 

W.  A.  Evans,  M.  D., 
Chicago,  Nov.  6,   1908.  Commissioner  of  Health. 

THE  FLY  CAMPAIGN  IN  FLORIDA. 
It  gives  me  pleasure  to  send  you  under  separate  cover  a  "fly  card"* 
which  the  State  Board  of  Health  of  Florida  has  lately  published  and  distributed. 
I  think  that  you  will  discern  from  this  poster  the  position  of  this  board  in 
regard  to  these  disease-carriers,  and  as  confirming  the  reports  of  Shakespeare, 
Vaughan  and  others  as  to  the  danger  which  the  fly  is  as  a  constant  menace  to 
the  public  h&alth  in  conveying  the  typhoid  fever  on  its  proboscis  and  feet. 

Joseph  Y.  Porter,  M.  D., 
Key  West,  Fla.,  Nov.  5,  1908.  State  Health  Officer. 

DR.  GOTTFRIED  KOEHLER,  CHIEF  FOOD  INSPECTOR  OF  DEPART- 
MENT OF  HEALTH  OF  THE  CITY  OF  CHICAGO,  SAYS: 

We  have  been  actively  engaged  in  a  crusade  against  the  transmission 
of  this  disease  [typhoid]  by  flies  during  the  past  year.  In  1902,  when  we  had 
quite  an  epidemic  of  typhoid  fever  in  this  city,  Dr.  Alice  Hamilton  made  some 
investigations  on  the  above  named  question  and  came  to  the  conclusion  that 
flies  were  an  important  medium  for  the  transmission  of  typhoid.  Her  article 
appeared  in  Vol.  40,  "Journal  of  the  American  Medical  Association,"  page  576.  It 
was  entitled,  "The  Fly  as  a  Carrier  of  Typhoid."  The  work  was  done  in  the 
laboratory  of  the  Memorial  Institute  for  Infectious  Diseases. 
Chicago,  Nov.  5,  1908. 

'Reproduced  opposite  page  47  o(  this  pamphlet. 

u 


FLIES  CARRY  GERMS  FROM  EXCRETA  TO  FOOD. 

I  have  not  been  making  any  special  investigations  with  regard  to  this 
matter,  but  am  of  the  firm  opinion  that  a  large  percentage  of  the  cases  of 
typhoid  fever  which  cannot  be  traced  directly  to  contaminated  water,  milk  or 
other  food  products  are  caused  by  the  infection  of  food  by  flies  that  have  had 
access  to  some  privy  or  place  where  the  excreta  of  typhoid  fever  patients  is 
present.  The  fact  that  from  two  to  three  per  cent  of  all  cases  of  typhoid  fever 
are  now  recognized  as  being  more  or  less  chronic  bacilli-carriers  only  empha- 
sizes the  danger.  Even  if  every  case  was  properly  nursed,  and  the  excreta 
properly  disinfected  during  the  active  stage  of  the  disease,  the  danger  may  still 
be  present  for  months  and  even  years  in  some  cases.  Flies  having  access  to  the 
excreta  of  such  people  become,  of  course,  just  as  dangerous  as  if  these  people 
were  actively  suffering  from  the  disease.  Of  course  it  is  difficult  to  prove  fly 
infection  in  specific  cases.  I  have  lately  had  brought  to  my  attention  four 
cases  of  typhoid  fever  in  one  family,  in  which  the  likelihood  of  flies  carrying 
the  disease  is  considerable.  There  is  a  privy  vault  on  the  premises,  and  the 
undisinfected  excreta  of  the  first  patient  were  deposited  in  it.  The  other -three 
cases  were  not  taken  sick  for  several  weeks,  and  were  all  children  who  did  not 
nurse  the  first  case  at  all,  and  this  case  was  removed  shortly  after  the  onset  of 
the  disease.  Flies  were  very  prevalent.  We  caught  some  of  them  and  are 
making  a  bacteriological  examination  of  them  to  see  if  we  can  find  any  typhoid 
fever  bacilli.  This  work  has  not  yet  been  completed  and  it  is  doubtful  whether 
or  not  we  will  succeed  in  isolating  the  desired  organisms.  Of  course  a  nega- 
tive result  will  be  of  no  significance. 

With  regard  to  my  opinion  as  to  the  transmission  of  typhoid  fever  through 
polluted  milk  and  water,  there  is  no  question  that  these  two  media  are  fre- 
quently the  vehicle  of  the  disease,  but  I  could  not  give  an  opinion  as  to  the 
percentage  of  typhoid  fever  contracted  from  milk  and  water  and  from  fly  infec- 
tion. Selskar  M.  Gunn,  M.  D., 
Orange,  N.  J.,  Nov.  4,  1908.  Health  Ofiicer. 
MOST  WASHINGTON  TYPHOID  DUE  TO  FLIES. 

In  a  public  address  before  a  convention  of  public  health  officers  held  in 
Oregon  in  1902,  I  stated  that  too  much  stress  was  laid  upon  the  pollution  of 
water  and  not  enough  upon  flies,  as  I  believed  the  vast  majority  of  cases  were 
due  to  the  latter.  While  I  do  not  believe  that  either  impure  milk  or  polluted 
water  is  directly  responsible  for  more  than  a  very  small  portion  of  typhoid 
fever  cases,  and  that  the  former  opinion  of  considering  these  two  articles  the 
source  of  all  cases  was  vicious,  inasmuch  as  it  has  prevented  proper  investiga- 
tions of  other  possible  and  probable  sources  of  the  disease,  I  do,  however, 
think  that  both  impure  milk  and  polluted  water  supplies  indirectly  increase  the 
number  of  typhoid  fever  cases,  by  the  fact  that  both  lower  the  resistance  of  the 
normal  healthy  person  to  this  disease,  and  thereby  enable  the  bacilli  to  thrive 
in  cases  where  they  would,  ordinarily,  with  pure  water  and  pure  milk,  not 
do  so.  They  are  also,  in  my  opinion,  capable  of  transmitting  the  typhoid  bacilli 
in  a  small  proportion  of  cases,  and  we  should,  therefore,  be  careful  not  to 
cause  the  pendulum  to  swing  too  far  the  other  way,  so  that  they  will  not  be 
considered  in  connection  with  an  investigation  of  this  disease. 

Elmer  E.  Heg,  M.  D., 
Seattle,  Wash.,  Nov.  10,  1908.  Secretary  State  Board  of  Health 


AGENCY  OF  FLIES  IN  SPORADIC  CASES  OF  TYPHOID. 

That  typhoid  germs  may  be  transmitted  by  flies  has,  it  seems  to  me, 
been  abundantly  proved,  especially  in  our  experience  during  the  Spanish- 
American  War.  That  typhoid  bacilli  may  be  transmitted  through  impure  milk 
and  water  supplies  there  is  absolutely  no  question.  The  numerous  epidemics  of 
typhoid  on  record,  proved  to  have  been  caused  through  both  these  agencies,  are 
convincing  beyond  question.  As  to  the  cause  of  many  so-called  sporadic  cases, 
the  source  of  which  is  generally  not  discovered,  I  am  of  the  opinion  that  flies 
may  be  one  of  the  prolific  factors,  but  to  what  extent  is  a  matter  of  conjecture. 

Concord,  N.  H.,  Nov.  4,  1908.  Irving  A.  Watson,  M.  D. 

FROM  THE  SECRETARY   OF  THE  DELAWARE  STATE   BOARD 
OF  HEALTH. 

This  Board  has  always  acknowledged  the  grave  dangers  of  polluted 
water  and  milk  supplies,  and  in  all  epidemics  has  especially  investigated  these 
acknowledged  sources  of  infection.  My  individual  opinion  as  to  the  trans- 
mission through  the  medium  of  flies  is  that  they  are  common  carriers  of  typhoid 
bacilli.  Of  course  typhoid  fever  is  with  us  when  Jack  Frost  has  sent  the  fly 
to  his  winter  quarters.  A.  E.  Fr.\ntz,  M.  D. 

Wilmington,  Del.,  Nov.  7,  1908. 

FLIES   MORE   DEADLY  THAN    SPANISH    BULLETS. 

The  communicability  of  typhoid  fever  through  the  medium  of  the  house- 
fly has  interested  me  ever  since  the  Spanish-American  War.  I  have  made  a 
compilation  of  figures  regarding  typhoid  fever  as  we  saw  it  then.  It  shows 
that  of  133,513  men,  22,420  had  typhoid  fever,  from  which  1,924  died;  the 
number  of  deaths  from  all  causes  was  2,197.  Comparing  this  with  the  exper- 
ience of  the  Twenty-third  Regiment,  U.  S.  Infantry,  encamped  at  the  James- 
town Exposition  grounds  for  six  months  in  the  summer  of  1907,  we  have  an 
object-lesson  that  should  be  known  to  all.  The  latter  organization  had  only 
about  two  per  cent  of  sickness  of  all  kinds,  virtually  had  no  flies  or  mosquitoes, 
though  living  on  swampy  ground  only  ten  feet  above  ocean  level.  Reports  of 
its  experience  can  be  found  in  copies  of  the  "Military  Surgeon"  for  the  latter  part 
of  that  year.  In  this  locality  we  have  had  rather  more  than  our  usual  number 
of  fall  typhoid  cases,  in  persons  who  have  had  their  summer  outings  in  tents  and 
in  attendance  at  camp  meetings. 

D.  S.  Burr,  M.  D., 
Binghamton,  N.  Y.,  Nov.  8,  1908.  Health  Officer. 

FLIES  SPREAD  TYPHOID  MORE   RAPIDLY  THAN  MILK  OR  WATER. 

During  the  past  summer  there  were  some  two  hundred  cases  of  typhoid 
directly  traceable  to  the  water  supply  contaminated  by  sewage,  the  foci  of  infec- 
tion following  plainly  the  line  of  the  water  mains  so  infected.  In  none  of  these 
cases  (except  in  so  far  as  the  fly  may  have  played  an  important  part  in  trans- 
ferring the  contagion  from  patient  to  patient  in  food  products,  etc.)  could  the 
fly  be  charged  with  having  carried  the  original  infection.  On  the  other  hand, 
the  writer,  who  was  then  surgeon  of  the  Thirteenth  United  States  Infantry,  can 
positively  state  that  the  outbreak  of  typhoid  fever  in  the  army  camps  at  Mobile 

13 


and  Tampa  in  the  spring  and  summer  of  1898  was  directly  traceable  to  the  fly 
as  the  chief  and  practically  only  medium  of  transmission  of  the  disease. 

The  facts  given  above  would  indicate  my  opinion  as  to  the  transmission 
of  the  disease  through  polluted  milk  and  water  supply.  I  am  inclined  to  the 
opinion,  however,  that,  once  started  in  a  community  through  any  original  source, 
the  danger  and  liability  of  extension  of  the  disease  through  the  medium  of  the 
house-fly  is  incomparably  greater  than  from  polluted  milk  or  water  only,  without 
the  fly.  William  B.  Winn, 

St.  Louis,  Mo.,  Nov.  6,  1908.  Assistant  Health  Commissioner. 

FLIES  JOINTLY  RESPONSIBLE  WITH    POLLUTED  WATER 
AND    MILK. 

I  am  firmly  convinced  from  the  experiments  of  others  and  my  general 
observation  and  knowledge  of  the  habits  of  the  fly  that  it  is  a  factor  of  consid- 
erable importance  in  the  spread  of  such  diseases  as  typhoid  fever.  I  am  certain 
from  investigations  of  epidemics  which  I  have  made  in  Iowa  and  from  my 
knowledge  of  the  investigations  of  epidemics  made  by  other  competent  and  reli- 
able men,  that  epidemics  of  typhoid  fever  are  often  the  result  of  polluted  water 
supplies  and  frequently,  also,  of  milk  that  has  been  polluted  either  by  water  or 
more  directly  by  individuals  who  carry  typhoid  bacilli  with  them.  I  certainly 
believe  that  milk  and  water  represent  a  far  more  important  source  of  infection 
than  flies.  Henry  Albert,  M.  D., 

Director  Hygienic  Laboratory,  Iowa  State  University. 
Iowa  City,  Nov.  10,  1908. 

FLY-BORNE  TYPHOID  VERY  FREQUENT  IN   VIRGINIA. 

I  believe  that  very  few  of  our  typhoid  epidemics  in  Virginia  are  caused 
by  polluted  water  or  milk.  Flies  certainly  play  a  very  large  part  in  the  epidemi- 
ology of  die  disease.  This  department  will  be  glad  to  furnish  you  any  further  in- 
formation in  regard  to  the  matter  that  you  may  desire,  or  co-operate  with  you  in 
any  investigation  of  the  matter.  The  small  local  epidemics  in  Virginia  towns  offer 
very  inviting  fields  for  the  study  of  typhoid,  and  it  is  the  purpose  of  this  depart- 
ment to  put  several  men  on  the  problem  next  summer. 

Allen  W.  Freeman,  M.  D., 
Richmond,  Va.,  Nov.  9,  1908.  Assistant  State  Health  Commissioner. 

FLIES  SHOULD   BE   KEPT   FROM   SEWAGE. 

I  have  had  occasion  to  investigate  a  number  of  typhoid  outbreaks  in  this 
State,  some  of  which  I  have  attributed  to  flies,  although  perhaps  no  more  fre- 
quently than  to  impure  milk  and  polluted  water.  Flies,  milk  and  water  I  con- 
sider the  common  causes  of  the  disease,  and  believe  the  fact  that  typhoid  fever 
is  most  prevalent  at  the  season  of  the  year  when  flies  are  most  numerous  is 
significant.  Since  we  know  that  two  or  three  per  cent  of  all  persons  who  have 
had  typhoid  fever  become  chronic  bacilli  carriers,  and  that  there  are  many  walk- 
ing cases  of  the  disease  which  go  unrecognized,  it  is  evident  how  important  is  the 
proper  disposal  of  sewage,  so  that  it  cannot  be  accessible  to  flies  or  be  carried  by 
heavy  rains  into  our  springs  and  water  supplies.  The  proper  disposal  of  sewage 
and  excrement  is  the  most  important  question  in  the  prevention  of  typhoid  fever. 

Joseph  H.  Townsend, 
Hartford,  Conn.,  Nov.  6,  1908.  Secretary  State  Board  of  Health. 


FLIES  AN   IMPORTANT  FACTOR  IN   MARYLAND  TYPHOID. 

I  firmly  believe  that  flies  are  an  important  factor  in  the  dissemination  of 
typhoid  in  our  State.  Unsanitary  conditions  which  exist  around  the  homes  of  the 
general  public,  especially  in  the  country  districts,  make  the  control  of  this  pest  of 
paramount  importance. 

I  was  interested  yesterday  to  hear  a  discussion  by  Dr.  C.  W.  Stiles,  of  the 
Marine  Hospital  Service,  Washington,  D.  C,  at  the  first  meeting  of  the  Commis- 
sion on  Country  Life.  He  stated  that  typhoid  fever  was  distinctly  a  farm  disease, 
from  an  extended  investigation  that  he  had  conducted  throughout  the  Union  in 
comparing  the  number  of  cases  in  the  country  and  in  the  city.  It  was  also  shown 
that  typhoid  fever  was  more  prevalent  in  those  States  where  flies  were  present 
for  a  longer  period  throughout  the  year  and  reproduced  more  rapidly.  He  stated 
that  in  the  majority  of  farmers'  homes  that  he  had  visited  in  the  South  there  were 
no  privies,  especially  for  the  laboring  class,  and  that  in  districts  where  the  negro 
population  was  greatest  this  disease  was  more  prevalent  among  the  whites. 

Congratulating  you  upon  the  great  work  that  you  are  accomplishing,  I  am, 
Very  truly  yours, 

Thomas  B.  Symons, 
College  Park,  Md.,  Nov.  lo,  1908.  State  Entomologist. 

NO  DISPUTE  AS  TO  TRANSMISSION  BY  FLIES. 
This  department  is  satisfied  that  typhoid  bacilli  in  drinking  water  and  milk 
are  a  common  source  of  infection.  We  have  had  two  or  three  typhoid  epidemics 
through  the  milk  in  this  State  during  the  last  twelve  months.  That  flies  transmit 
the  disease  I  think  cannot  be  disputed,  given  the  necessary  conditions  and  their 
access  to  typhoid  excreta  and  to  food.  I  think  that  the  deductions  obtained  from 
the  investigations  at  Camp  Wyckoff  at  Montauk  Point,  after  the  Spanish  War, 
was  an  illustration  which  came  very  close  to  our  doors. 

Gardner  T.  Swarts,  M.  D., 
Providence,  R.  I.,  Nov.  9,  1908.  Secretary   State  Board  of  Health. 

"COMMON   CARRIERS"  OF  TYPHOID    BACILLI. 

It  is  the  opinion  of  this  Board  that  polluted  milk  and  water  supplies  are  the 
main  sources  of  typhoid  fever  in  localities  where  sewers  are  in  use.  Where  in- 
fected faeces  or  urine  are  deposited  in  open  places  or  vaults  we  believe  that  flies 
act  as  common  carriers  of  the  typhoid  bacilli. 

GusTAVus  A.  Badger, 
Lynn,  Mass.,  Nov.  18,  1908.  Clerk   Board  of  Health. 

FROM   THE    HEALTH    DEPARTMENT   OF   OAKLAND,   CAL. 

This  Health  Department  has  made  no  investigations  to  establish  the  possi- 
bility of  fly  transmission  of  typhoid,  but  it  is  our  belief  that  the  fly  is  a  frequent 
carrier  of  the  agents  of  infection  in  typhoid  as  well  as  several  other  contagious 
diseases.  We  believe,  however,  that  the  common  mode  of  transmission  is  by 
drinking  water  polluted  with  sewage ;  and  we  know  that  certain  epidemics  have 
occurred  through  pollution  of  milk  with  the  typhoid  bacilli  at  the  dairy.  The 
epidemic  of  a  few  years  ago  in  our  neighboring  city  of  Palo  Alto  was  directly 
traced  to  milk  pollution.  E.  W.  Ewer,  M.  D., 

Health  Ofl^cer. 
Oakland,  Cal.,  Nov.  12,  1908. 


MICHIGAN  TYPHOID  CASES  TRACED  TO  FLIES. 

We  have  some  data  bearing  on  the  agency  of  flies  in  the  spread  of  typhoid 
fever,  thirty-eight  cases  having  been  reported  as  traced  to  flies,  together  with 
some  data  relating  to  precautions  exercised  toward  exclusion  of  flies  from  the 
sick  room  of  a  typhoid  fever  patient. 

Because  the  recognition  of  flies  as  an  agency  in  the  spread  of  typhoid 
fever  and  tuberculosis  is  of  such  recent  growth,  and  because  we  have  meagre  data 
on  which  to  base  an  opinion,  I  fear  I  cannot  give  you  much  assistance  on  this 
point ;  but  at  the  same  time  I  may  say  that  I  do  not  doubt  that  flies  are  a  greater 
agency  in  the  spread  of  these  two  diseases  than  we  can  at  present  say.  I  am  not 
ready  to  subscribe  to  the  belief  that  they  are  of  greater  importance  than  either 
water  or  milk.  F.  W.  Shumway^  M.  D., 

Secretary   State  Board  of  Health. 
Lansing,  Mich.,  Nov.  17,  1908. 

FLIES  A  DANGER  IN  PUBLIC  INSTITUTIONS. 
It  has  been  my  observation  in  our  institutions  that  the  scattering  cases  of 
typhoid  are  mostly  traceable  to  milk  and  especially  the  water  supplies.  In  schools 
(industrial,  blind,  etc.)  prisons,  soldiers'  homes,  etc.,  when  large  outbreaks  have 
occurred  after  single  cases  it  has  usually  been  traceable  to  flies.  Usually  the 
cause  of  the  first  case  is  uncertain.  Louis  Leroy,  M.  D., 

Bacteriologist. 
Memphis,  Tenn.,  Nov.  19,  1908. 

GENERAL  BENEFIT  OF  ANTI-FLY  CAMPAIGNS. 
I  have  always  considered  the  fly  a  potential  danger  which  varies  greatly 
under  different  conditions.  Just  how  much  disease  to  attribute  to  this  insect  pest 
in  the  aggregate  would  be  a  difiicult  matter  to  estimate.  I  believe  that  the  move- 
ment for  the  restriction  of  the  fly  nuisance  a  good  one ;  for  whatever  makes  for 
cleanliness  by  the  prompt  removal  of  filth  and  refuse  from  our  environment  and 
its  ultimate  distruction  as  a  breeding  ground  for  flies  opposes  to  a  certain  degree 
the  transmission  of  many  other  disease  germs  than  those  which  the  fly  presum- 
ably carries.  Theobald  Smith,  M.  D., 

Harvard  University  Medical  School. 
Boston,  Nov.  13,  1908. 

FLIES  RESPONSIBLE  FOR  A  LARGE  PERCENTAGE  OF  TYPHOID 
CASES. 

The  Board  of  Health  of  this  city  has  always  held  the  common  house-fly  re- 
sponsible for  the  transmission  of  typhoid  in  a  large  percentage  of  cases.  The 
annual  report  of  the  Board  of  Health  for  the  fiscal  year  ending  July  i,  1907, 
describes  experiments  that  conclusively  prove  the  house-fly  responsible  for  prac- 
tically 151  cases  of  typhoid  fever  subsequent  to  the  great  earthquake  and  fire. 

W.  C.  Hassler,  M.  D., 
San  Francisco,  Nov.  23,  1908.  Chief  Sanitary  Inspector. 

TYPHOID  DEATH-RATE  CUT  IN   HALF  BY  FLY  CAMPAIGN. 
We  have  been  making  strenuous  efforts  to  protect  the  homes  of  this  city 
against  flies.    I  am  very  glad  to  state  that  the  death-rate  from  typhoid  fever,  with 

16 


the  same  water  supply,  has  been  more  than  cut  in  half  so  far  this  season.  We  be- 
lieve that  work  along  these  lines  has  produced  remarkable  results.  However,  it 
is  but  fair  to  say  we  have  been  making  strenuous  efforts  to  put  the  city  in  better 
sanitary  condition  in  other  respects.  Our  milk  supply  has  been  carefully  watched, 
as  has  the  ice  supply.  We  believe,  nevertheless,  that  keeping  the  flies  from  our 
homes  has  produced  very  important  results. 

J.  E.  Crichton,  M.  D., 
Seattle,  Wash..  Oct.  21,  1908.  Commissioner  of  Health. 

MILK  INFECTED  THROUGH  FLIES. 
In  my  opinion  flies  are  responsible  for  more  transgressions  along  the  lines 
stated  than  people  at  present  appreciate,  especially  as  relates  to  typhoid  fever.  I 
am  convinced  that  in  many  instances  typhoid-infected  milk  results  from  contami- 
nation through  flies.  There  was  a  notable  example  of  this  within  my  observation 
two  or  three  years  ago  in  which  the  circumstances  seemed  to  prove  that  the  milk 
produced  by  a  small  dairy,  which  was  responsible  for  typhoid  fever  in  twenty-six 
families,  was  infected  by  contact  with  flies.  At  a  previous  time  there  had  been 
a  case  of  typhoid  on  the  premises  and  the  excreta  had  been  deposited  in  a  privy 
vault  without  having  been  disinfected.  T.  B.  Beatty, 

Salt  Lake  City,  Utah,  Nov.  27,  1908.  Secretary    State  Board  of  Health. 

FROM  THE  MAINE  STATE  BOARD  OF  HEALTH. 
Basing  our  opinion  upon  the  statements  of  other  persons  outside  of  our 
members,  we  believe  that  flies  constitute  a  serious  source  of  danger  when  they 
have  access  alike  to  typhoid  infection  and  food  supplies.  While  I  am  not  in  a 
position  to  make  any  positive  statements  on  this  point,  my  personal  belief  is  that 
infected  milk  and  infected  water  supplies  are  far  from  being  an  inconsiderable 
cause  of  typhoid  fever.  A.  G.  Young,  M.  D., 

Secretary. 
Augusta,  Me.,  Nov.  5,  1908. 

CINCINNATI'S  EXCELLENT  TYPHOID  RECORD. 
Cincinnati  has  had  a  most  interesting  experience  during  the  last  year. 
During  the  month  of  October,  1908,  there  were  but  thirty  cases  of  typhoid  re- 
ported, notwithstanding  that  this  disease  was  practically  epidemic  throughout  the 
entire  valley,  and  the  low  state  of  the  Ohio  River  (the  lowest  in  many  years) 
had  made  it  practically  an  open  sewer.  The  fact  that  Cincinnati  has  not  exper- 
ienced the  worst  epidemic  of  typhoid  in  its  history  I  ascribe  to  the  wonderful  work 
of  our  newly  completed  municipal  water  works.  Of  these  thirty  cases  reported 
in  October,  fully  one-half  were  children,  for  the  most  part  infants.  From  this  it 
can  be  readily  inferred  either  that  infection  occurred  through  the  milk  supply  or 
that  in  children  there  is  a  susceptibility  to  the  typhoid  germ.  Personally  I  believe 
that  it  is  due  to  a  polluted  milk  supply,  as  the  milk  conditions  of  our  city  are  truly 
deplorable.  In  Newport,  Kentucky,  there  have  recently  been  over  thirty  cases  of 
typhoid  fever  traced  to  one  dairyman.  While  I  recognize  the  agency  of  flies  in 
the  conveyance  of  typhoid,  also  the  possibility  of  the  contagiousness  of  the  disease, 
yet  I  believe  that  the  large  majority  of  cases  are  due  to  polluted  drinking  water. 

Mark  A.  Brown,  M.  D., 
Cincinnati,  Nov.  12,  1908.  Health  Officer. 

17 


UNITED  ACTION  AGAINST  THE  FLV  IN  MASSACHUSETTS. 

I  have  in  hand  your  note  of  the  3rd  inst.,  with  reference  to  flies  and 
typhoid  fever.  It  is  a  pleasure  to  report  to  you  from  two  sources,  the  Health 
Department  and  the  special  committee  of  the  Massachusetts  Association  of  Boards 
of  Health.  From  the  former  Board  I  may  say  that  no  definite  plan  of  warfare 
has  been  adopted.  The  matter  has  been  under  consideration  for  a  long  time, 
and  it  is  through  the  action  of  the  Boston  Board  that  the  Massachusetts  Asso- 
ciation has  taken  up  the  matter.  The  reason  for  this  is  that  it  seemed  as  if 
the  different  boards  could  better  take  up  the  matter  with  a  uniform  policy,  rather 
than  with  a  different  one  for  each  few  square  miles  of  territory.  Any  success- 
ful war,  therefore,  would  not  only  affect  the  immediate  territory  interested,  but 
would  be  a  factor  towards  the  immunity  of  neighboring  communities.  With 
reference  to  the  Health  Department  of  the  City  of  Boston,  I  may  say  that  the 
attitude  is  conservative.  We  know  that  the  fly  can  carry  infection,  but  we  are 
utterly  unable  to  say  to  what  extent.  We  have  been  able,  in  most  of  our  epi- 
demics, to  trace  the  infection  to  milk  or  the  well-water  with  which  the  utensils 
were  washed.  In  our  latest  cases  it  was  an  employee  on  the  milk  farm  or  at  the 
dairy.  The  drinking  supply  in  the  larger  cities  of  Massachusetts  is  pretty  well 
guarded,  so  that  we  do  not  now  look  for  much  typhoid  from  that  source.  On  the 
contrary,  the  country  supplies  are  not  well  guarded.  We  are  regarding  the  in- 
fection by  the  means  of  flies  as  possible,  and  as  a  factor  to  the  spread  of  the 
disease,  but  we  consider  it  as  yet  not  to  be  a  major  factor,  and  believe  that  the 
niiiiv  infection  is  much  more  dangerous. 

In  July  the  Massachusetts  Association  appointed  a  committee  to  con- 
sider the  fly  nuisance.  This  committee  included  Dr.  C.  V.  Chapin,  of  Prov- 
idence, chairman;  Dr.  Charles  E.  Simpson,  of  Lowell,  Dr.  Lyman  A.  Jones, 
of  North  Adams ;  James  C.  Coffey,  of  Worcester,  and  John  Ritchie,  Jr.,  of  Bos- 
ton. A  printed  circular*  prepared  by  Dr.  Chapin,  used  by  him  in  his  Providence 
work,  was  presented  by  the  Committee  at  the  meeting  of  the  Massachusetts 
Association,  and  it  was  voted  to  continue  the  committee  and  empower  it  to 
secure  the  distribution  of  the  circulars  during  the  winter  and  early  spring,  so  as 
to  catch  the  next  fly  season  in  advance.  John  Ritchie,  Jr., 

City  Health  Commissioner. 
Boston,  Nov.  6,  1908. 

A  CANADIAN  OPINION. 

I  can  refer  you  to  no  investigation  in  re  transmission  of  typhoid  fever 
by  the  medium  of  flies.  However,  I  believe  them  to  be  one  cause  of  its  propa- 
gation, none  of  the  others  being  excluded,  among  them  the  well  known  source 
of  infection  by  the  medium  of  polluted  water  supply. 

E.  Pelletier,  M.  D., 
Secretary,   Board  of  Health,   Province  of  Quebec. 
Montreal,  Canada,  Nov.  4,  1908. 

TWO   WATER-BORNE   EPIDEMICS   IN   OREGON. 
We  have  made  no  investigation  of  the  transmission  of  typhoid  fever  by 
flies,  although   it  is   the  opinion  of  our  board  that  this   is  one  of  the   most 
ipiportant  ways.     With  regard  to  the  transmission  of  typhoid   fever  by  impure 

•Reproduced  on  page  46  of  this  pamphlet. 

IS 


milk  and  polluted  water  supply,  I  will  say  that  we  have  had  two  serious  epidemics 
in  this  State,  one  occurring  at  Eugene  in  1905,  in  which  the  water  supply  was 
polluted  directly  from  the  sewer  system,  and  another  occurring  at  The  Dalles, 
Oregone,  in  which  the  infection  was  traced  to  the  water  supply.  Bacteriological 
examination  of  this  water  demonstrated  the  presence  of  faecal  infection. 

Robert  C.  Yenney,  M.  D., 
Portland,  Ore.,  Nov.  7,  1908.  State  Health  Officer. 

FROM  DR.  L.  R.  THURLOW,  HEALTH  OFFICER  OF  PLAINFIELD,  N.  J. 

Thus  far  tliis  year  we  have  had  two  distinct  outbreaks  of  typhoid  fever. 
The  first  was  in  August,  and  there  were  eight  cases  at  the  time,  all  of  which 
were  in  one  neighborhood.  The  second  was  in  October,  when  eighteen  cases 
were  reported.  In  both  of  these  instances  the  importance  of  transmission  of 
the  disease  by  flies  was  carefully  considered.  The  first  outbreak  occurred  in  a 
good  portion  of  the  city ;  there  were  no  vaults  or  cesspools,  and  the  houses  were 
all  well  screened.  The  second  outbreak  was  not  confined  to  any  one  locality,  and 
the  indications  seemed  to  indicate  a  milk  infection.  We  were,  however,  unable 
to  find  any  possibility  of  infection  on  the  dairy  premises,  or  in  any  part  of  the 
transportation  or  delivery  of  the  milk. 

In  regard  to  the  transmission  of  typhoid  fever  by  impure  or  polluted 
water  compared  with  the  transmission  of  flies,  my  experience  points  to  water 
as  the  most  important  source  of  infection;  second  to  this,  milk. 
Plainfield,  N.  J.,  Nov.  20,  1908. 

A   MILITARY  CAMP   EPIDEMIC  CAUSED   BY   FLIES. 

At  the  time  of  the  Spanish-American  War  the  Fifteenth  Minnesota  Vol- 
unteers, encamped  at  the  Fair  Grounds,  suffered  an  epidemic  of  typhoid.  The 
State  Board  of  Health  investigated  the  epidemic  and  published  their  findings  in 
their  annual  report.  This  epidemic  was  shown  to  have  been  spread  by  flies,  and 
so  far  as  I  know  was  the  first  epidemic  of  typhoid  studied  from  that  point  of 
view.  There  is  no  doubt  that  typhoid  is  spread  by  means  of  an  impure  milk  and 
water  supply,  though  no  epidemics  have  been  traced  to  that  cause  here,  as  our 
water  and  milk  supply  is  excellent  J.  M.  Armstrong,  M.  D., 

St.  Paul,  Minn.,  Nov.  27,  1908.  Assistant  Commissioner  of  Health. 

FLIES   MOST   DANGEROUS   IN   CAMPS. 

The  writer  is  of  the  opinion  that  flies  play  no  part  in  the  present  increase 
in  cases  of  typhoid  in  this  city,  as  the  increase  began  during  March,  and  the 
decrease  during  the  summer  months.  During  the  past  summer,  which  was 
extremely  dry,  there  was  a  decrease  in  the  number  of  cases,  but  I  am  expect- 
ing more  trouble  as  a  result  of  the  present  and  future  rainfalls.  I  am  of  the 
opinion  that  flies  play  a  very  important  part  in  spreading  the  disease  under 
certain  conditions,  such  as  prevail  in  camps  where  sanitation  is  imperfectly 
maintained.  Milk  is  such  an  excellent  culture  for  germs  that  it  is  easily  con- 
taminated if  placed  in  cans  washed  in  water  containing  typhoid,  or  if  exposed 
to  an  atmosphere  contaminated  with  germs  of  scarletina  or  diphtheria.  This 
is  too  well  known,  doubtless,  to  require  mention. 

R.  W.  Robinson,  M.  D.. 
Auburn,  N.  Y.,  Nov.  20,  1908.  Health  Officer. 


CASES  CASTING  SUSPICION  UPON  FLIES. 
At  the  request  of  Mr.  E.  S.  Allen,  I  am  forwarding  certain  information 
in  regard  to  cases  of  typhoid  fever  at  the  "Mountain  House  Property"  in  this 
village.  John  Flannery — age  twelve  years — had  been  sick  some  two  weeks ; 
no  doctor  in  attendance ;  was  removed  to  St.  Mary's  Hospital  on  November  23 ; 
typhoid  fever.  He  had  been  visiting  in  West  Orange  and  Millburn  about  a 
month  before  removal.  Own  water  supply  and  own  milk  supply.  No  milk 
or  water  used  on  premises  except  own  supply.  No  oysters  used.  At  this 
date  the  rest  of  the  family  were  in  perfect  health.  On  October  5,  Willie — age 
thirteen  years — and  Leo — age  eight  years — were  removed  to  Memorial  Hospital. 
Annie — age  six  years — was  not  feeling  well,  but  was  not  sick  enough  to  stay 
in  bed.  On  October  24  Annie  was  removed  to  Memorial  Hospital.  Sample  of 
water  examined  showed  but  slight  amount  of  organic  matter,  probably  due 
to  leaves  in  spring.  Flies  were  then  caught  in  a  cage  placed  in  the  closet 
in  which  milk,  cake  and  bread  were  kept.  Colon  bacilli  have  been  isolated  from 
the  feet  of  these  flies.  Up  to  the  present  we  have  been  unable  to  get  typhoid 
bacilli,  but  probably  may  be  able  to  identify.  The  house  was  swarming  with 
flies.  The  privy,  standing  seventy-five  feet  from  unscreened  window,  contained 
numerous  flies.  There  was  a  direct  connection  between  the  room  in  which  the 
food  closet  was  situated  and  the  unscreened  window.  Although  these  people 
were  told  after  the  first  case  to  kill  all  the  flies  and  to  disinfect  the  privy,  there 
was  no  evidence  that  anything  had  been  done.  The  board  cleaned  the  house, 
floors,  etc.,  killed  flies  and  disinfected  the  privy  after  October  15. 

A.  C.  Benedict, 
South  Orange,  N.  J..  Nov.  23,  1908.  Health   Department  Inspector. 

PITTSBURG  SUFFERS  MOST  FROM  WATER. 
During  the  past  year  typhoid  fever  sank  to  about  one-fourth  its  previous 
prevalence.  We  had  an  increase  in  August  in  about  the  usual  proportion. 
There  is  one  reason  why  the  great  epidemic  prevalence  of  typhoid  fever  in 
Pittsburg  cannot  be  explained  by  flies,  and  that  is  that  we  have  almost  as 
much  typhoid  fever  in  the  cold  weather  as  in  the  warm.  It  is  also  true  that 
where  houses  are  not  connected  with  sewers  the  methods  of  disposal  of  excreta 
do  not  favor  the  access  of  flies,  owing  to  darkness.  I  do  not  mean  by  this 
expression  to  assert  that  flies  have  nothing  to  do  with  the  dissemination  of 
typhoid  fever  during  the  warmer  months,  but  they  certainly  do  not  cause  the 
excessive  typhoid  fever  rate  which  we  have  been  accustomed  to  until  the  past 
year.  E.  T.  Matson,  M.  D., 

Executive  Officer    Typhoid   Commission,   Bureau  of  Health. 
Pittsburgh,  Pa.,  Nov.  17,  1908. 

FROM    DR.  JAMES   BOSLEY,   HEALTH   COMMISSIONER   OF 
BALTIMORE. 

We  are  familiar  with  the  report  of  Dr.  Jackson  and  indorse  the  con- 
clusion that  the  common  house-fly  is  a  possible  carrier  of  disease  under  certain 
conditions.  As  far  as  Baltimore  is  concerned,  we  have  as  yet  had  but  little 
evidence  that  the  fly  has  been  directly  concerned  in  the  transmission  of  typhoid 
fever,  which  we  believe,  however,  to  be  due  more  to  the  fact  that  the  fly  has 
not  been  in  contact  with  typhoid  stools,  than  to  its  inability  to  carry  the  organism 

20 


PRIVY  VAULTS,   SWARMING   WITH  FLIES,  ADJOINING   KITCHEN   DOOR 

These  conditions,  inviting  disease  and  insuring  the  pollution  of  food,  are  practically  duplicated  in  hundreds 

of  towns  besides  Pittsburg,  in  which  this  photograph  was  taken. 

By  courtesy  of  The  Surziy 


ii.Y  ON  I'iKCK  OK  si'o\(;k  cam-: 

Ills  lasl  proriicniiUc  may  have  been  iivor  uiiniciiliiinablc  lillb  in  tin 
of  the  (lininfi:  room, 
PhotoKraph  by  W.  I,.  I'nderwdiKl. 
iPerinlssioii  of  Douhlcday,  PateA  Co.) 


if  infected.  At  piesent  we  consider  that  typhoid  fever  in  Baltimore  is  mainly 
due  to  the  transmission  of  polluted  milk  and  polluted  water.  In  our  judg- 
ment transmission  of  typhoid  fever  by  flies  must  be  very  much  less  than  trans- 
mission by  milk  and  water. 

Baltimore,  Md.,  Dec.  5,  1908. 

A   NON-COMMITAL    REPORT. 

We  have  made  no  investigations,  but  feel  very  positive  that  flies  play  a 
most  important  part  in  the  transmission  of  typhoid  and  other  germs.     As  to 
the  relative  importance  of  flies  and  milk  or  water,  \ye  have  no  positive  informa- 
tion. C.  C.  Lytle,  M.  D. 
Geneva,  N.  Y.,  Dec.  5,  1908. 

TYPHOID   IN   MINING  CAMPS. 

I  know  of  no  cases  in  the  State  of  Wyoming  where  typhoid  fever  was 
transmitted  by  flies,  although  there  may  be  many  cases,  were  they  investigated, 
due  to  that  means  of  transmission.  I  do  know  that  we  have  typhoid  fever 
in  two  localities  in  the  State  of  Wyoming — mining  districts — where  the  disease 
is  epidemic  on  account  of  polluted  water  supply  for  domestic  purposes.  This 
has  been  investigated  on  two  or  three  occasions. 

Amos  W.  Barber, 
Cheyenne,  Wyo.,  Dec.  7,  1908.  Secretary   State  Board  of  Health. 

A  SCREENING  MOVEMENT  IN  GALVESTON. 

Our  Health  Department,  by  dint  of  having  all  cisterns  screened,  standing 
water  drained  oflf  or  coated  with  petroleum,  all  cesspools  in  the  outlying,  un- 
sewered  districts,  and  all  barrels,  etc.,  held  in  the  cotton  yards  for  fire  ex- 
tinguishing purposes,  treated  with  crude  carbolic  acid,  has  practically  exter- 
minated the  mosquito.  The  treating  of  cesspools  with  crude  carbolic  acid  and 
the  enforcement  against  permitting  accumulation  of  manure,  etc.,  has  very 
materially  lessened  the  fly  pest. 

We  are  now  preparing  an  ordinance  compelling  the  screening  of  all 
kitchens,  pantries,  dining-rooms,  etc.,  in  all  hotels,  boarding  houses,  restaurants, 
etc.,  and  butchers'  and  fishmongers'  shops,  fruit  stands  and  wagons,  and  I 
could  use  )'Our  promised  literature  to  very  good  advantage  in  popularizing  this 
screening   movement.  C.  W.  Tkuehe.\rt,  M.  D., 

Health  Oflficer. 
Galveston,  Tex.,  Dec.  2,  1908. 

MONEY   NEEDED   FOR  TEXAS   INVESTIGATIONS. 

In  reply  to  yours  of  the  30th  ult.,  will  state  that  this  department  has 
not  been  making  any  investigations  with  regard  to  the  transmission  of  typhoid 
or  other  germ  diseases  by  flies.  I  hope  your  committee  will  be  successful  in 
arousing  more  universal  interest  in  this  matter,  and  particularly  awaken  our 
section  and  our  Legislature  to  the  necessity  for  more  money  and  more  authority 
in  investigation  and  research  along  these  lines  in  our  State. 

William    M.   Brumby,    M.    D., 
Austin.  Tex..  Xov.  9.  1908.  State  Health  Officer. 

21 


THE   FLY  ONE  OF  THE  GREAT  TYPHOID-SPREADING  AGENCIES. 

I  have  made  no  investigations  as  to  the  transmission  of  typhoid  by  flies, 

other  than  in  a  general  way,  but  I  think  that  this  is  one  of  the  great  means. 

Dairies  often  spread  the  disease,  as  does  polluted  water,  but  these  are  not  the 

sole  causes.    Direct  contact  and  house  infection  are  also  means  of  transmission. 

In  fact,  I  recognize  any  means  which  transmits  the  germs  from  one  person  to 

another.     I  consider  milk  and  water  as  two  of  the  great  means  of  producing 

epidemics.  L.  M.  Powers,  M.  D., 

T       A       1       r-  1    XT       Q   T^^Q  Health  Officer. 

Los  Angeles,  Cal.,  Nov.  o,  1900. 

FROM  THE  HEALTH  OFFICER  OF  ALBANY,  N.  Y. 
In  my  judgment  abundant  evidence  exists  as  to  the  medium  of  flies  as 
a  means  of  transmission  of  germ  diseases,  and  every  effort  should  be  made  by 
the  various  political  divisions  of  the  State  and  by  individuals  and  societies  to 
prevent  the  propagation  of  flies,  by  the  proper  care  of  manure  and  other  breed- 
ing sources.  During  the  fly  season  efforts  should  be  made  in  localities  in  which 
flies  are  common  to  prevent  their  ingress  into  houses  and  their  proximity  to 
the  food  supply.  While  the  evidence  seems  to  be  sufficient  that  germ  diseases 
may  be  transmitted  through  flies,  it  is  extremely  doubtful  whether  flies  are 
often  or  ever  the  means  of  transmission  of  typhoid  fever.  I  know  of  no  inves- 
tigations showing  the  relation  of  cause  and  effect  between  typhoid  fever  and 
the  common  house-fly.  I  do  not  believe,  however,  that  flies  are  a  common 
source  of  origin  of  typhoid  fever.  The  evidence  appears  to  be  indisputable  that 
typhoid  fever  is  a  water-borne  disease  and  that  polluted  water  is  still  the 
most  active,  the  most  prominent  and  the  most  serious  cause  of  the  propagation 
of  typhoid  fever.  Enough  is  known  also  to  render  it  certain  that  a  minority  of 
the  cases  of  typhoid  fever  arise  from  a  polluted  milk  supply. 

Alt-         TvT    ^r    AT  o  Joseph  D.  Craig,  M.  D., 

Albany,  N.  Y.,  Nov.  11,  1908.  ^^^^^^  ^^^^^ 

SEWAGE  THE  MOST  COMMON  MEDIUM  OF  INFECTION. 
I  have  read  the  very  interesting  report  of  Dr.  Jackson  and  consider 
that  it  contains  matter  for  serious  thought.  It  is  my  opinion  that  typhoid 
can  be  transmitted  in  several  ways,  and  that  in  the  majority  of  instances  it 
is  media  other  than  flies  that  constitute  the  greatest  source  of  danger.  As  to 
the  principal  method,  with  the  ever-increasing  amount  of  sewage  in  the  public 
water  supplies,  it  seems  to  me  that  this  is  the  most  common  medium.  That 
flies  do  transmit  typhoid  bacilli,  I  think  the  experience  of  our  Spanish-American 
War  fully  establishes.  William  G.  Prince, 

Buffalo.  N.  Y.,  Nov.  9.  1908.  Bacteriologist    Department   of   Health. 

DANGER  OF  FLIES  IN  AUTUMN. 
I  am  of  the  opinion  that  a  great  deal  of  disease  is  carried  by  house- 
flies,  especially  in  the  fall  of  the  year,  when  people  are  prone  to  remove  their 
screens  too  early,  with  the  drying  up  of  the  grasses  and  other  vegetable  mat- 
ter. Probably  the  germs  that  repose  in  these  media  are  carried  into  houses 
when  no  obstructions  are  offered.  F.  J.   Patton, 

Duluth,  Minn.,  Nov.   10,   1908.  ^^^^^^  Commissioner. 


FLIES   HELD  TO   BE  "PROBABLE   FACTORS"   IN   TYPHOID 
TRANSMISSION. 

Though  this  bureau  has  made  no  special  investigations  of  flies  as  carriers 
of  disease,  we  have,  nevertheless,  looked  upon  them  as  probable  factors  in 
such  transmission.  We  have  accordingly  enforced,  in  so  far  as  it  was  pos- 
sible, regulations  aiming  to  protect  food-stuffs  exposed  for  sale,  against  flies, 
and  to  educate  people  in  the  matter  of  excluding  flies  from  their  houses, 
pantries,  etc.  As  to  the  roles  played  by  polluted  milk  and  water  in  the  dis- 
semination of  typhoid  fever,  permit  me  to  say  that  our  opinion  upon  this  point 
is  fixed  and  based  upon  what  we  regard  as  absolutely  convincing  argument. 
Until  the  introduction  of  filtered  water  in  the  city  of  Philadelphia  we  were 
notorious  as  a  typhoid  center.  With  the  introduction  of  filtered  water  in  this 
city  typhoid  fever  has  been  practically  eliminated  from  those  districts  receiving 
that  water,  and  its  elimination  progresses  with  the  extension  of  the  system 
carrying  purified  water.  On  the  milk  question,  we  have  on  our  records  several 
cases  in  which  typhoid  fever  was  conveyed  by  milk,  as  convincing  as  circum- 
stantial evidence  could  make  them.  A.  C.  Abbott, 
Philadelphia,   Pa.,  Nov.   5,   1908.                                 Chief   Bureau  of  Health. 

HOUSE-FLIES  UNDOUBTEDLY  CARRY  TYPHOID  GERMS. 
It  has  been  proved  beyond  a  question  of  doubt  that  typhoid  fever 
may  be  transmitted  by  the  common  house-fly.  That  the  disease  may  be  acquired 
through  polluted  milk  and  water  is  a  well-established  fact.  It  is  difficult  to  say 
which  of  the  causative  factors  indicated  is  responsible  for  the  greater  number 
of  cases  of  typhoid  fever.  However,  but  few  sanitarians,  in  my  opinion,  will 
subscribe  to  the  statement  that  typhoid  infection  from  milk  and  water  is  insignif- 
icant as  compared  with  that  through  the  agency  of  flies. 

James  A.  Egan,  M.  D., 
Springfield,  111.,  Nov.  3,  1908.  Secretary   State  Board  of  Health. 

DIFFICULTY  OF  TRACING  FLY  INFECTION. 
The  experience  of  this  department,  covering  five  years,  and  the  investi- 
gation of  5,808  cases  of  typhoid  fever,  have  indicated  their  distribution  as  to 
causation  as  follows : 

Cases  imported  into  the  District  of  Columbia,  of  unknown  origin,  940. 
Cases  of  local  origin: 

Contact  cases    366      7.51  percent. 

Due  to   milk 135       2.77  per  cent. 

Of  unknown  origin 4>367     89.72  per  cent. 

Some  of  the  cases  of  unknown  origin  are  doubtless  due  to  polluted  water, 
and  some  are  probably  due  to  flies.  It  is  very  difficult,  however,  to  trace  infec- 
tion by  flies  with  any  degree  of  accuracy.  Such  observations  as  have  been 
made  by  this  department  indicate  that  the  extent  to  which  flies  act  as  carriers 
of  typhoid  fever  infection  is  much  exaggerated.  In  view  of  the  possibilities, 
however,  of  the  dissemination  of  disease  through  these  pests,  the  Health  De- 
partment is  doing  whatever  it  can  to  diminish  the  number  of  flics  in  the  com- 
munity and  toward  preventing  them  from  contaminating  food  products. 

William  C.  Woodward.  M.  D., 
Washington,  D.  C,  Nov.  9,  1908.  Health  OflScer. 

23 


UNDECIDED  AS  TO  TYPHOID  SOURCES. 

I  have  not  made  any  investigations  as  to  typhoid  transmission  by  flies. 

As  to  typhoid  transmission  by  milk  or  water,  here  in  Galveston  the  city  water 

is  artesian  well-water  mainly,  and  typhoid  from  water  infection  can  almost  be 

excluded,  only  a  few  wooden  cisterns  being  used.      During  the  past  summer 

there  were  a  number  of  mild  cases  of  typhoid  in  Galveston  which  were  attributed 

to  the  distribution  of  the  germs  by  flies,  but  as  to  whether  the  flies  were  the 

real  carriers  or  not  was  not  worked  out. 

/-  1      .        T^         ivT  o  M.  A.  Wood. 

Galveston,  Tex.,   Nov.   14,   1908. 

IMPORTANCE  OF  PROPER  DISPOSITION   OF  TYPHOID   DISCHARGES. 

(Replying  to  your  letter  of  November  4,  I  would  say  that  I  have  not 
made  any  investigations  personally  with  regard  to  the  transmission  of  typhoid 
germs  by  flies,  but  it  stands  to  reason  that  this  is  one  of  the  many  methods  of 
disseminating  typhoid  fever.  Replying  to  your  further  inquiry,  I  would  say 
that  I  think  it  a  great  practical  and  theoretical  error  to  attempt  to  lay  special 
stress  upon  any  one  means  of  transmission  to  the  exclusion  of  the  many  other 
means  which  exist;  not  only  can  typhoid  fever  be  transmitted  by  flies,  but 
also  by  milk,  water  and  other  means.  It  seems  to  me  that  in  general  it  would 
be  well  to  emphasize  the  important  fact  that  the  infectious  material  is  found  in 
concentrated  form  in  the  discharge ;  hence,  when  this  is  properly  disposed  of, 
the  work  of  safeguarding  against  typhoid  is  reduced  to  a  minimum. 

C.  W.  Stiles, 

Chief  Division  of  Zoology,  Public  Health  and  Marine  Hospital  Service. 
Washington,  D.  C,  Nov.  5,  1908. 

FLIES  AS  ACTIVE  AGENTS   IN   TRANSMITTING  TYPHOID. 

We  have  made  no  special  investigation  with  regard  to  transmission  of 
typhoid  and  other  germ  diseases  through  the  medium  of  flies.  We  have  real- 
ized, however,  that  undoubtedly  the  common  house-fly  has  been  an  active  agency 
in  the  transmission  of  disease,  and  in  our  lectures  emphasize  the  danger  of 
such  transmission  and  the  necessity  of  eliminating,  as  far  as  possible,  this  factor. 
In  regard  to  the  transmission  of  typhoid  fever  and  the  forces  bringing  this 
about,  experience  proves  to  us  that  milk  and  polluted  water  are  undoubtedly 
very  active  agencies.  We  have  had  in  recent  years  two  milk  epidemics  of 
typhoid  fever.  In  one  case  we  traced  116  cases  of  typhoid  in  the  city  of  Port 
Washington  to  a  dairyman  who  had  typhoid  in  his  own  family.  One  hundred 
and  fifteen  of  these  cases  were  using  milk  from  this  man.  One  patient  did  not 
receive  his  milk  from  this  source,  but  was  a  frequent  visitor  of  a  restaurant 
where  milk  was  obtained  from  this  dairyman.  This  epidemic  was  in  the  early 
autumn  and,  strange  as  it  may  seem,  there  were  no  other  cases  of  typhoid  fever 
at  this  time  in  this  city,  with  a  population  of  about  5,000.  We  have  just  had 
an  epidemic  of  typhoid  fever  in  the  city  of  Sheboygan,  due  to  polluted  water 
from  Lake  Michigan,  precipitated  probably  from  a  large  leak  in  one  of  the 
intake  pipes  and  a  defect  in  the  wall  of  the  well  connecting  with  a  flue  extending 
to  the  lake  shore  some  twenty  feet  away.  The  epidemic  at  Sheboygan  was 
not  confined,  however,  entirely  to  the  users  of  water  furnished  by  the  water 
company.     It  was  more  or  less  distributed  throughout  the  city  in  the  homes 

24 


of  well-water  users,  but  largely  confined  to  the  adult  population  who  were 
active  business  people  and  liable  therefore  to  obtain  drinking  from  various 
points  throughout  the  city.  The  fly  here  may  have  been  a  factor  in  the  trans- 
mission of  this  disease.  I  cannot  believe  that  the  transmission  through  infected 
milk  and  water  is  insignificant  in  comparison  with  other  agencies.  My  obser- 
vation leads  me  to  believe  that  these  are  fundamentally  the  dangerous  factors. 
We  are  examining  much  well  water  and  water  furnished  by  a  water  system  in 
the  smaller  localities,  and  in  a  large  percentage  of  our  investigations  we  find 
polluted  water  in  those  localities  where  typhoid  is  reported. 

C.  A.  Harper,  M.  D., 
Madison,   Wis.,   Nov.   6,    1908.  Secretary   State  Board  of  Health. 

SPORADIC  CASES  OFTEN   DUE  TO    FLIES. 

There  is  no  question  in  my  mind  but  that  severe  epidemics  of  typhoid, 
outside  of  hospital  or  army  quarantines,  are  nearly  all  due  to  the  milk  or  water 
supply.  Sporadic  cases  and  epidemics  often  have  their  origin  by  the  germ 
having  been  carried  by  the  fly.  Dr.  Ralph  W.  Cornell, 

Health  Commissioner, 
Omaha,  Neb.,  Nov.  6,  1908. 

FROM  DR.  G.  A.  BADING,  MILWAUKEE'S  HEALTH  OFFICER. 

There  can  be  no  question  of  the  possibility  of  transmission  of  typhoid 
bacilli  by  means  of  flies,  particularly  in  districts  where  sewage  facilities  are 
not  provided  and  where,  consequently,  the  old-fashioned  vaults  are  still  in  use. 
This  is  not  the  case  in  our  city,  and  for  that  reason  the  particular  subject  of 
transmission  of  typhoid  by  means  of  flies  has  not  concerned  us  to  any  extent. 
We  have  had  several  instances  where  mild  typhoid  epidemics  in  particular 
localities  were  unquestionably  due  to  an  infected  milk  supply,  and  only  last 
year  had  a  nest  of  typhoid  cases  which  we  traced  to  polluted  water,  there  being 
a  shallow  well  from  which  the  water  supply  had  been  furnished.  On  investi- 
gation, the  well  water  was  found  polluted  to  such  an  extent  as  to  lead  us  to 
ascribe  the  outbreak  to  that  source. 

Milwaukee.   Wis.,    Nov.   7,    1908.   . 

EXPERIENCE  OF  A  NEBRASKA  ENTOMOLOGIST. 
In  reply  to  your  communication  of  November  4  regarding  the  trans- 
mission of  typhoid  and  other  diseases  by  flies,  I  wish  to  report  as  follows: 
I  have  never  made  any  specific  experiments  along  the  line  suggested,  but  have 
carefully  compiled  statistics  and  other  accounts  that  have  led  me  to  believe 
that  the  house-fly  (Musca  domcstica)  and  several  of  its  allies  are  responsible 
for  varying  percentages  of  germ  diseases  that  attack  human  beings.  These 
percentages  depend  upon  conditions  and  circumstances  that  vary  among  them- 
selves. In  the  case  of  the  work  of  Dr.  Jackson,  with  which  I  am  acquainted 
only  thrtjugh  the  report  which  was  issued  July  last,  it  can  be  seen  that  flies 
caused  a  very  large  percentage  of  the  contamination.  I  believe  that  under  cer- 
tain conditions  the  typhoid  germ  can  be  and  is  transmitted  by  the  contamination 
of  drinking  water,  milk,  etc.  A  number  of  years  ago  our  family  had  a  siege 
of  typhoid  fever.  Eight  members  sufl^ered  attacks  from  the  disease.  We  had 
just  moved  into  a  new  country  and  used  river  water  for  domestic  purposes.  Our 


parents  and  grandparents  drank  tea  and  coffee  and  escaped  the  contamination, 
while  seven  children  and  a  servant  drank  water.  All  of  those  using  water  came 
down  with  typhoid  in  due  time.  Other  persons  in  the  small  town  contracted 
the  disease  also.  Investigation  revealed  a  case  of  the  disease  ten  miles  up 
stream  some  weeks  previously,  where  the  sewage  from  the  sick  room  was 
thrown  into  the  river.  Other  cases  likewise  occurred  further  down  stream. 
Cases  of  typhoid  have  been  traced  to  the  use  of  milk  right  here  in  Lincoln,  both 
where  the  disease  occurred  in  the  family  of  the  milk  man  and  where  germs 
of  the  disease  were  found  in  the  well-water  used  in  washing  milk  cans.  Of 
course  in  some  of  these  last  named  instances  the  flies  might  readily  have  been 
the  agency  for  spreading  the  bacilli.  Lawrence  Bruner, 

State  Entomologist. 
Lincoln,  Neb.,  Nov.  7,  1908. 

FROM  DR.  F.  H.  PECK,  HEALTH  OFFICER,  UTICA,  N.  Y. 

While  we  have,  never  made  any  investigation  in  regard  to  the  trans- 
mission of  typhoid  and  other  germs  through  the  medium  of  house-flies,  we 
have  no  doubt  that  this  is  a  frequent  cause  of  infection.  As  to  the  transmission 
through  impure  milk,  it  is  generally  conceded  that  the  only  impurities  of  milk 
that  will  carry  are  its  infection  through  impure  water  supply,  either  through 
adulteration  or  the  use  of  water  in  washing  milk  utensils.  We  believe  that 
the  most  potent  source  of  typhoid  infection  is  polluted  water. 

Utica,  N.  Y.,  Nov.  7,   1908. 

MILK   FREQUENTLY   INFECTED   BY   FLIES. 

We  have  been  able  to  trace  one  small  epidemic  of  typhoid  to  a  city 
dairy  where  in  our  opinion  the  milk  was  infected  by  flies  which  had  received 
the  infected  organism  from  an  overflowing  vault.  In  this  city  typhoid  is  un- 
common; the  cases  which  occur  from  polluted  water  are  few  and  are  limited 
to  the  users  of  surface  wells.  It  has  for  some  time  been  the  opinion  of  this 
department  that  typhoid  in  Fort  Wayne  was  chiefly  the  result  of  infected  milk, 
of  flies  and  of  contact  infections ;  but  the  exact  relationship  existing  between 
these  factors  we  have  been  unable  to  determine.  It  is  to  be  borne  in  mind, 
however,  that  milk  is  frequently  infected  by  flies. 

H.  O.  Bruggerman,  M.  D., 
Fort  Wayne,  Ind.,  Nov.  7,  1908.  Secretary    Board  of  Health. 

TYPHOID  AND  "CARRIER"  CASES. 

My  opinion  is  that,  while  flies  may  be  a  factor  of  some  moment,  in  such 
places  as  military,  lumber  or  mining  camps,  under  ordinary  conditiors  which 
prevail  in  our  cities  flies  have  little  part  in  the  spread  of  typhoid  fever.  It  does 
not  seem  to  me  that  the  evidence  printed  by  your  committee  was  at  all  con- 
clusive. As  regards  water  infection,  I  believe  that  in  very  many  communi- 
ties a  large  amount  of  typhoid  fever — in  some  cities,  most  of  it — is  caused  by 
contaminated  water.  In  such  cities  as  New  York  and  Providence  I  believe 
that  practically  no  typhoid  fever  is  due  to  infected  water.  I  doubt  -f  milk 
causes  much  typhoid,  except  in  the  way  of  sharp  outbreaks.  On  the  whole, 
perhaps  5  to  10  per  cent,  of  our  typhoid  fever  may  be  considered  to  be  due  to 
milk,  though  I  rather  incline  to  the  smaller  figure.     In  cities  with  a  good  water 

26 


supply  and  few  privy  vaults,  like  New  York  and  Providence  I  believe  that  by 
far  the  larger  part  of  the  typhoid  fever  is  caused  by  contact  infection,  and 
tliat  "carrier"  cases  are  an  extremely  important  factor  in  its  spread. 

Charles  V.  Chapin, 
Providence,   R.   I.,  Nov.  4,   1908.  Superintendent  of  Health. 

FROM    DR.   SAMUEL   A.   DIXON,    PENNSYLVANIA'S    HEALTH 
OFFICER. 

In  answer  to  your  letter  of  the  2nd  inst.,  I  beg  to  say  that  the  statistics 
of  the  world  show  that  water  is  responsible  for  the  transmission  of  typhoid 
fever  more  than  anything  else  known,  and  I  believe  iinpur^^  milk  is  a  close 
second. 
Harrisburg,  Pa.,  Nov.  5.  1908. 

FROM  THE  STATE  HEALTH   OFFICER  OF  ALABAMA. 

While  I  am  satisfied  that  flies  play  an  important  role  in  transmitting 
typhoid  fever,  and  possibly  other  diseases,  yet  I  am  satisfied  that  typhoid  fever 
is  not  infrequently  transmitted  through  polluted  milk  and  water. 

W.  H.  Sanhers,  M.  D., 
Montgomery,  Ala.,  Nov.  4,  1908. 

ALL  THREE   CAUSES  OPERATE   IN    MARYLAND. 

The  question  of  the  relative  importance  of  the  fly  in  transmitting  typhoid 
fever  is  only  to  be  determined  by  the  importance  of  other  hygienic  factors. 
With  an  extremely  bad  water  supply,  transmission  by  flies  and  milk  becomes 
relatively  unimportant.  When  the  water  supplies  are  improved,  we  find  a  larger 
proportion  of  cases  due  to  infected  milk,  direct  contagion,  and  the  action  of 
flies.  I  regard  winter  typhoid  fever  as  due  almost  exclusively  to  water.  I  do 
not  consider  that  there  is  any  warrant  for  the  statement  that  all  other  causes 
of  transmission  of  typhoid  are  insignificant  as  compared  to  that  contracted 
through  the  medium  of  flies.  Marshall  L.  Price,  M.  D., 

Secretary   State  Board  of  Health. 
Baltimore,  Md.,  Nov.  4,  1908. 

MONTCLAIR,  N.  J.,  HAS  ABOLISHED  VAULTS. 
Owing  to  the  small  number  of  cases  of  typhoid  fever  that  we  have  in 
a  community  of  this  size,  local  investigations  would  be  of  slight  value.  In  order 
to  prevent  the  spread  of  this  disease  by  flies  we  have  abolished  practically  all 
of  the  privy  vaults  in  town,  and  have  declared  all  such  vaults  to  be  a  nuisance, 
by  ordinance.  We  also  try  to  secure  proper  screening  of  houses  in  which  there 
is  typhoid  fever.  I  hardly  see  how  there  can  be  any  question  of  the  danger 
of  transmission  of  typhoid  fever  by  the  use  of  impure  water  and  milk,  for  they 
can  become  contaminated  by  the  specific  germs  at  any  time,  and  the  epidemics 
that  have  been  traced  to  infected  milk  and  water  supplies  are  extremely  numer- 
ous. C.  H.  Wells,  M.  D., 

Health  Officer. 
Montclair,  N.  J.,  Nov.  13,  190S. 

27 


FROM  THE  MASSACHUSETTS  BOARD  OF  HEALTH. 

Of  eighteen  local  outbreaks  of  typhoid  fever  in  different  parts  of  Massa- 
chusetts, investigated  under  the  direction  of  Dr.  Charles  Harrington,  late  secre- 
tary of  this  board,  during  the  years  1905  and  1906,  fourteen  were  traced  to  milk 
and  three  to  polluted  private  or  semi-private  water  supplies.  One  could  not  be 
explained.  In  eleven  of  the  fourteen  outbreaks  traced  to  milk,  there  was  a  his- 
tory of  typhoid  fever  at  the  place  of  production,  and  in  the  others  there  was 
none.  Dr.  Harrington's  opinion  of  the  matter,  stated  in  his  own  words,  is  as 
follows : 

"With  suitable  State  supervision  of  milk  production,  under  which  it 
would  be  unlawful  under  heavy  penalty  to  ship  milk  from  dairies  where  typhoid 
fever  or  other  diseases,  communicable  through  milk,  are  known  to  exist  until  the 
authorities  are  satisfied  that  it  can  be  done  with  entire  safety,  such  outbreaks 
could  be  largely  prevented ;  but  under  the  most  practicable  and  efficient  super- 
vision there  will  be  milk-borne  typhoid  outbreaks  which  cannot  be  traced  to  any 
antecedent  case  on  the  farm.  This  is  because  in  any  community  in  which 
typhoid  is  endemic,  there  exist  numbers  of  persons  who  are  unconscious  car- 
riers and  disseminators  of  the  typhoid  bacillus." 

William  C.  Hanson,  M.  D., 
Boston,  Mass.,  Nov.  12,  1908.  Acting  Secretary. 

CORNELL  EPIDEMICS  FROM  MILK  AND  WATER. 
We  have  no  data  concerning  flies.  We  do  know  that  our  typhoid  epidemic 
five  years  ago  was  due  to  polluted  water.  It  occurred  in  the  winter  time,  and 
those  drinking  water  not  connected  with  the  infected  water  supply  escaped 
trouble.  This  year  ten  cases  of  mild  typhoid  occurred,  and  on  investigation 
we  discovered  that  all  ten  received  milk  from  one  man.  As  all  came  down  with 
the  disease  about  the  same  time,  and  as  we  have  about  thirty  milk  dealers,  we 
feel  sure  that  infection  in  this  instance  was  due  to  milk. 

H.  H.  Crum,  M.  D., 
Ithaca,  N.  Y.,  Nov.  5,  1908.  Health  Officer. 

FROM  THE  "OLD  NORTH  STATE." 

I  have  made  no  special  observation  as  to  the  transmission  of  typhoid 
fever  by  flies,  but  I  believe  that  the  disease  is  still  transmitted  to  a  very  con- 
siderable extent  by  infected  water  and  milk.  This  is  especially  true  where 
the  outbreak  is  extensive.  Richapo)  H.  Lewis,  M.  D., 

Secretary,  State  Board  of  Health. 
Raleigh,  N.  C,  Nov.  9,   1908. 


The  compiler  of  this  pamphlet  wishes  to  acknowledge  the  assistance 
given  him  in  his  work  not  only  by  those  whose  letters  or  other  writings  are 
quoted,  but  also  by  the  following: 

G.  S.  Dimmick,  Inspector  of  Milk  and  Foodstuffs,  Galveston,  Tex. 

Joseph  H.  Beek,  Secretary,  St.  Paul  Jobbers'  and  Manufacturers'  Asso- 
ciation, St.  Paul,  Minn. 

Melville  F.  Rogers,  M.  D.,  Secretary,  Savin  Hill  Improvement  Associa- 
tion, Dorchester,  Mass. 

Laura  Keisher,  M.  D.,  Bureau  of  Labor,  Washington,  D.  C. 

Thomas  F.  Wiseman,  Secretary,  Board  of  Health,  Fall  River,  Mass. 

Morris  Knowles,  Chief  Engmeer,  Bureau  of  Filtration,   Pittsburg,    Pa. 

2S 


THE  TRANSMISSION  OF  DISEASE  BY  FLIES* 

By  Daniel  D.  Jackson,  S.  B. 

Flies,  as  carriers  of  disease,  have  engaged  the  attention  of  sanitarians 
for  a  decade  or  more,  but  it  has  been  only  within  the  last  two  years  that  ex- 
tensive studies  have  been  made  to  establish  the  extent  to  which  this  method  of 
transmission  is  carried  on. 

This  recent  work  has  produced  a  fuller  realization  of  the  gravity  of  the 
situation,  and  my  remarks  on  this  occasion  are  intended  to  give  you  a  resume 
of  what  has  been  brought  out  by  the  work  of  the  Merchants'  Association  Com- 
mittee in  New  York  City,  and  to  make  a  broader  use  of  the  principles  involved, 
so  as  to  apply  to  a  greater  or  less  degree  to  the  majority  of  cities  in  this  coun- 
try and  to  any  city,  town  or  village  in  any  country  where  sanitary  laws  are 
neglected. 

One  of  the  first  to  suggest  that  the  transmission  of  typhoid  fever  was 
in  many  cases  due  to  the  agency  of  the  house-fly  was  Dr.  George  M.  Kober,  of 
Washington,  D.  C.  In  the  report  of  the  Health  Officer  of  the  District  of  Colum- 
bia, June  30,  1895,  he  states  that  flies  may  carry  to  our  food  supply  infectious 
matter  gathered  from  box  privies  and  from  other  exposed  faecal  deposits. 

Seven  years  previous  to  this  Celli  had  shown  that  flies  fed  with  pure  cul- 
tures of  typhoid  fever  bacilli  excreted  the  germs  in  a  virulent  condition. 

In  1897  Dr.  Wallace  Clarke,  Health  Officer  of  Utica,  N.  Y.,  noted  that 
60  per  cent,  of  the  contagious  diseases  in  Utica  occurred  in  the  Eighth  Ward, 
a  locality  not  overcrowded  and  under  the  same  general  sanitary  regulations  as 
the  rest  of  the  city.  He  found,  however,  that  the  garbage  dump  in  this  ward 
had  been  used  also  as  a  dump  for  human  excrement,  and  that  during  August 
(the  time  of  the  epidemic  of  intestinal  disease  in  that  city)  these  dumps  were 
swarming  with  flies.  He  at  that  time  attributed  the  cause  of  the  disease  to 
fly  transmission.  These  dumps  have  since  been  removed  and  proper  sanitary 
methods  of  sewage  and  garbage  disposal  have  been  adopted,  and  the  death  rate 
of  the  Eighth  Ward  of  Utica  has  been  thereby  reduced  to  normal. 

In  September,  1898,  Dr.  H.  A.  Veeder  published  in  the  New  York 
"Medical  Record"  a  paper  entitled,  "Flies  as  Spreaders  of  Disease  in  Camps." 
in  which  he  showed  that  these  insects  were  the  carriers  of  typhoid  fever  in 
the  army  camps  during  the  Spanish-American  War.  Similar  data  were  brought 
out  by  Dr.  George  M.  Sternberg,  Surgeon-General,  United  States  Army,  in 
the  Philadelphia  "Medical  Journal"  of  June,  1899. 

The  same  year  Dr.  George  H.  F.  Nuttall  wrote  an  excellent  paper  on  the 
role  of  insects  in  the  spread  of  disease  in  Volume  VIII.  of  the  Johns  Hopkins 
Hospital  Reports.  The  "Report  on  the  Origin  and  Spread  of  Typhoid  Fever 
in  the  United  States  Military  Camps  during  the  Spanish-American  War  of 
1898,"  by  Drs.   Reed,  Vaughan  and   Shakespeare,  shows  that  every   regiment 

•Read  bffore  the  joint  convention  of  the  American  Civic   Association  and  the   National    Municipal 
League,  at  HiltsburK,  Nov.  10,  1008. 

29 


constituting  the  First,  Second,  Third,  Fourth,  Fifth  and  Seventh  Army  Corps 
developed  typhoid  fever,  and  that  more  than  90  per  cent,  of  the  volunteer 
regiments  developed  it  within  eight  weeks  after  going  into  camp.  This  report 
also  shows  that  not  infected  water,  but  infected  flies,  were  the  important  factor 
in  the  spread  of  the  disease  in  these  camps,  and  in  spite  of  the  fact  that  more 
than  80  per  cent,  of  the  total  deaths  were  caused  by  typhoid  fever. 

Following  these  revelations.  Dr.  L.  O.  Howard,  Entomologist  of  the  De- 
partment of  Agriculture,  published  several  papers  on  the  habits  of  the  house- 
fly, in  one  of  which  (Farmer's  Bulletin  No.  155,  1902)  he  showed  that  the  fly 
was  a  potent  factor  in  the  transmission  of  typhoid  in  country  districts,  due  to 
neglected  box  privies. 

It  remained  for  the  Water  Pollution  Committee  of  the  Merchants'  Asso- 
ciation of  New  York  to  show  that  the  fall  rise  of  typhoid  fever,  which  occurs 
in  most  cities,  and  the  enormous  summer  death  rate  of  children  from 
diarrhoeal  diseases  are  also  chiefly  chargeable  to  that  most  detestable  of  insects, 
the  common  house-fly.  In  1907  this  Committee  was  appointed  by  the  Merchants' 
Association  to  study  and  to  take  measures  to  prevent,  as  far  as  possible,  the 
increasing  pollution  of  the  inland  waters  of  New  York  State.  Among  the 
first  efforts  of  the  Committee  was  a  study  of  the  pollution  of  New  York  Harbor 
and  the  sanitary  condition  of  the  water-front. 

The  Committee's  report,  published  in  December  of  the  same  year,  shows 
by  careful  sanitary  inspections  and  by  statistical  and  bacteriological  data  that 
the  activity  of  the  house-fly  is  the  chief  cause  of  intestinal  diseases  in  New 
York  City.  Further  investigations  have  shown  that  in  most  cities  where  the 
water  supply  is  not  contaminated,  and  in  fact  everywhere  throughout  the  world 
where  water  supplies  are  good,  the  house-fly  is  the  chief  source  of  typhoid 
fever  and  other  intestinal  diseases  by  the  transmission  of  the  germs  of  exposed 
faecal  matter  to  the  food  used  for  human  consumption. 

I  will  endeavor  to  give  a  brief  outline  of  the  studies  of  our  Committee 
and  then  to  show  you  that  their  conclusions  have  a  wider  and  more  important 
application  than  was  at  first  deemed  possible. 

The  reports  of  a  corps  of  inspectors  along  the  water-front  of  Greater 
New  York  all  showed  the  presence  of  exposed  fsecal  matter;  in  some  cases 
solid  matter  from  sewers  not  removed  by  the  tides  and  in  many  instances  due 
to  the  intolerable  toilet  conditions  on  the  docks.  During  the  hot  weeks  in  sum- 
mer these  human  excreta  were  found  to  be  swarming  with  flies.  By  the  use 
of  staining  fluids,  and  by  other  methods  these  flies  were  shown  to  be  traveling 
back  and  forth  from  this  filthy  material  to  the  food  of  the  nearby  restaurants 
and  homes.  Microscopic  examinations  of  these  flies  showed  them  to  be  carry- 
ing on  their  mouths  and  legs  considerable  quantities  of  the  filthy  matter  over 
which  they  had  walked,  and  this  matter,  as  would  be  expected,  contained  many 
thousands  of  faecal  bacteria.  It  was  then  demonstrated  by  bacterial  methods 
that  this  faecal  matter  containing  disease  germs  would  be  strewn  about  on  food 
wherever  the  fly  walked. 

A  careful  study  of  the  seasonal  prevalence  of  flies  by  means  of  daily 
counts  from  fly  cages  in  different  parts  of  the  city  showed  that  they  were  active 
in  large  numbers  only  in  the  comparatively  few  hot  weeks  of  summer,  while 
the  health  statistics  showed  that  these  were  the  weeks  when  an  abnormal  num- 
ber of  cases  of  typhoid  fever  and  diarrhoea  were  contracted.     The  reported 

30 


!r^ 


CHART     No.     3 


(January    F'e/firuary  March      /Ipril         Alay         (June         duly        Augifsf    Sepf ember  October  Noi'ember  December 


DR£5DtM 
MUNICH 


C/fy'es  hav/nff  ffOodlVater 
Supplies  and  oen-affe  DMpos- 
(3h.  anc/  txce/lent  Oenera/ 
Sanifarj  Cond/fions,  Shon- 
inff  Uniform/y  Lort"  Typhoid 
Pate  Peffardte6s  ofTewper- 
ati/re. 


BJLTIMORt 

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CJtJes  hai^lnff  fatrty  ffood 
lYater  6c/pp//e6.  t>i/t  a/  time 
11  (?/  C/iar/lfiff,  Co/npara/tye/y 
Poor  (Se/ra^e  D/\spo6at6 
or  Bad  Oenerat  Sanitary 
Condltlor/tS,  atton/r/ff  of//)e 
trar?<s/nljs/o/i  of  DIdease 
dy  Pt/eJ  and  a  Mont/iJy 
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(Jam/an     r^bruary    Marrt?      4pr/l 


dc/nc         tJu/y       ^i/ffi/sf    Seplember  Oclober  /Voi-eml>er  Decemtier 

O/^o^^M    6/fo/r/A/C7  ^ycRAGC  Mo/vthly 

l/^i?Mr/o/vs  Av  r///-  TvPMoio  /^cyc/?  Dc>ith  P^t^s  or  Tfip/^t- 

Typ^s  or  Cities 

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Pemperature. 


MERCHANTS  ASSOCIAriON 

COMMITTCC  ON  POLLUT/ON    Of    THC 

Waters  or  New  York 

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ALB£l>TitW!l£RycSR,MO      0/tm£L  O.Mc/tSOfl 


CHART    No.     1 


number  of  cases  of  these  diseases  rose  with  the  rise  in  the  prevalence  of  flies 
and  fell  with  but  slight  lag  with  the  decrease  in  the  numbers  of  flies  trapped. 

Finally  maps  were  made  showing  by  black  dots  the  location  of  every 
fatal  case  of  intestinal  disease  during  the  fly  season.  A  black  belt  was  found 
to  run  along  the  water-front.  Most  of  the  deaths  were  within  three  blocks 
of  the  shore  line.  Wherever  there  was  any  material  exception  to  the  rule 
investigation  showed  the  presence  of  exposed  out-houses  and  faecal  matter 
swarming  with  flies;  in  other  words,  conditions  as  bad  as  along  the  water- 
front. Here  also,  then,  had  filth  and  flies  combined  in  the  destruction  of 
human  life. 

Do  not  think  for  a  moment  that  because  you  do  not  live  in  New  York 
these  matters  do  not  directly  affect  each  and  every  one  of  you  here.  The 
statistics  in  practically  all  American  cities — and  in  many  foreign  cities,  too, 
for  that  matter — show  a  marked  rise  in  the  number  of  deaths  from  typhoid 
fever  and  intestinal  diseases  during  the  fly  season. 

In  cities  where  flies  are  the  chief  cause  of  intestinal  epidemics  the  other 
seasons  of  the  year  show  comparative  freedom  from  the  disease,  while  in  cities 
where  water  and  milk  epidemics  exist  these  epidemics  may  occur  at  any  season 
of  the  year.  The  milk  epidemic,  however,  often  takes  place  during  the  fly  sea- 
son because  of  the  infection  of  milk  by  flies  at  the  farm  or  in  the  local  milk 
depots. 

The  danger  to  health  is  greatest  in  parts  of  the  city  where  sanitary 
precautions  are  most  neglected,  but  even  if  you  live  in  a  comparatively  well- 
cared-for  part  of  town  do  not  receive  the  fly  into  your  home  as  a  harmless 
visitor,  for  he  may  come  in  a  carriage  or  on  horseback  from  the  filthiest  spot 
in  the  city. 

Hitherto  the  fly  has  been  regarded  complacently  as  a  harmless  nuisance 
and  considered  to  be  an  annoying  creature  with  great  persistence  and  excessive 
familiarity.  Regarded  in  the  light  of  recent  knowledge  the  fly  is  more  dan- 
gerous than  the  tiger  or  the  cobra.  Worse  than  that,  he  is,  at  least  in  our 
climate,  much  more  to  be  feared  than  the  mosquito  and  may  easily  be  classed, 
the  world  over,  as  the  most  dangerous  animal  on  earth. 

It  has  been  for  some  time  thoroughly  well  demonstrated  that  he  is  one 
of  the  chief  agencies  in  the  spread  of  Asiatic  cholera.  We  now  know  him  to 
be  the  source  of  a  high  percentage  of  the  cases  of  typhoid  fever  and  the  chief 
disseminator  of  diarrhceal  diseases,  from  which  about  7,000  children  die  annually 
in  New  York  City  alone. 

On  Charts  No.  i  and  2,  which  are  presented,  can  be  seen  the  seasonal 
rise  and  fall  of  reported  deaths  from  typhoid  fever  and  other  diarrhceal  dis- 
eases. It  will  be  noted  that  year  after  year  they  correspond  to  the  rise  and 
fall  of  the  prevalence  of  house-flies. 

On  Chart  No.  2  is  shown  a  comparison  of  the  weekly  death  ratee  per 
100,000  from  diarrhoea!  diseases  of  children  for  six  typical  American  cities.  The 
cities  represented  by  full  lines  had  at  the  time  of  charting  good  water  supplies, 
comparatively  free  from  contamination,  while  those  given  by  the  broken  lines 
had  poor  or  questionable  water  supplies. 

It  will  be  noted  that  in  the  cities  of  the  first  type  the  deaths  of  children 
from  intestinal  disease  is  higher  throughout  the  year,  but  that  in  all  of  the  cities 

31 


a  sudden  and  very  marked  rise  takes  place  during  the  fly  season.     It  will  also  be 
noted  that  in  the  cities  further  south  the  rise  comes  earlier  in  the  year. 

On  Chart  No.  3  are  given  the  seasonal  rise  and  fall  of  three  diflFerent 
classes  of  cities: 

I.  Cities  having  good  water  supplies,  proper  sewage  disposal  systems 
and  excellent  general  sanitary  conditions,  showing  an  uniformly  low  typhoid 
rate  throughout  the  year,  regardless  of  temperature. 

II.  Cities  having  fairly  good  water  supplies,  but  at  the  time  of  chart- 
ing comparatively  poor  sewage  disposal  systems  or  bad  general  sanitary  con- 
ditions, allowing  the  transmission  of  disease  by  flies.  These  diagrams  show 
monthly  typhoid  death  rates,  which,  if  set  back  two  months  to  correspond  with 
the  contraction  of  the  disease,  follow  the  temperature  and  the  activity  of  the 
insects. 

III.  Cities  having  at  the  time  of  charting  poor  water  supplies  and 
uniformly  high  typhoid  rates  tliroughout  the  year  with  little  relationship  to  tem- 
perature. 

In  the  accompanying  table  will  be  found  the  actual  figures  by  weeks  dur- 
ing 1907  and  1908  of  the  deaths  from  diarrhoeal  diseases  in  New  York  City, 
and  the  number  of  flies  caught  in  traps  at  a  representative  station  in  the  city 
during  the  fly  season.  If  during  this  season  we  subtract  fifty  deaths  a  week  as 
being  the  normal  weekly  death  rate  from  diarrhoeal  diseases,  excluding  typhoid 
fever,  we  shall  have  4,496  deaths  due  to  flies  during  1907  and  4,012  deaths  due  to 
flies  during  1908. 

By  the  same  process,  if  we  subtract  six  deaths  a  week  as  being  the  normal 
death  rate  from  typhoid  fever  in  New  York  City,  due  to  imported  cases  and  direct 
transmission  from  these  cases,  we  have  about  330  deaths  from  typhoid  fever 
during  the  fly  season  in  1907  traceable  to  flies,  as  against  an  estimate  of  260 
deaths  from  the  same  causes  in  1908. 

In  other  words,  there  has  been  in  New  York  City  this  year  a  reduc- 
tion during  the  fly  season  of  about  seventy  deaths  from  typhoid  fever  and  484 
deaths  from  diarrhoea.  Most  of  the  unsanitary  conditions  pointed  out  in  last 
year's  report  have  not  yet  been  remedied.  These  evils  exist  in  most  of  our  cities 
as  well  as  in  our  country  districts,  and  we  as  Americans  should  agitate  this  mat- 
ter of  sewage  disposal  and  general  sanitation,  not  only  for  humane  purposes, 
but  for  patriotic  reasons  as  well,  so  that  we  may  not  feel  ashamed  to  compare 
our  death  rates  from  filth  diseases  with  those  of  European  cities. 


32 


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DAMAGES   FOR    SICKNESS   CAUSED   BY   FLIES 


The  courts  have  passed  upon  the  question  of  damages  for  a  sufferer  from 
typhoid  who  could  trace  his  illness  to  flies  feeding  upon  the  filth  of  sewage. 
A  few  years  ago  a  man  living  in  Germantown,  Philadelphia,  recovered  heavy 
damages  from  the  city  for  his  illness,  which  he  proved  was  caused  by  a  stream 
flowing  through  his  yard  which  had  been  polluted  by  sewage  from  a  house  ten- 
anted by  a  typhoid  patient.  The  defence  relied  upon  proof  that  the  plaintiff 
had  neither  drunk  from  nor  bathed  in  the  stream,  but  an  entomologist  con- 
vinced the  jury  that  he  had  contracted  the  disease  through  the  medium  of  flies 
which  had  carried  the  infection  from  the  stream  to  the  food  exposed  to  their 
visits  in  his  house. 


HOW  THE  "TYPHOID  FLY"  IS  FOUGHT  IN 
WASHINGTON 

Dr.    L.   O.   Howard,    Chief  of  the  Bureau  of  Entomology,  U.  S.  Department 
of  Agriculture,  in  Bulletin  No.  jS 

The  name  "typhoid  fly"  is  here  proposed  as  a  substitute  for  the  name 
"house-fly,"  now  in  general  use.  People  have  altogether  too  long  considered 
the  house-fly  as  a  harmless  creature,  or,  at  the  most,  simply  a  nuisance.  While 
scientific  researches  have  shown  that  it  is  a  most  dangerous  creature  from  the 
standpoint  of  disease,  and  while  popular  opinion  is  rapidly  being  educated  to  the 
same  point,  the  retention  of  the  name  house-fly  is  considered  inadvisable,  as  per- 
petuating in  some  degree  the  old  ideas.  Strictly  speaking,  the  term  "typhoid 
fly"  is  open  to  some  objection,  as  conveying  the  erroneous  idea  that  this  fly  is 
solely  responsible  for  the  spread  of  typhoid ;  but  considering  that  the  creature  is 
dangerous  from  every  point  of  view,  and  that  it  is  an  important  element  in  the 
spread  of  typhoid,  it  seems  advisable  to  give  it  a  name  which  is  almost  wholly 
justified  and  which  conveys  in  itself  the  idea  of  serious  disease.  Another  repul- 
sive name  that  might  be  given  to  it  is  "manure  fly,"  but  recent  researches  have 
shown  that  it  is  not  confined  to  manure  as  a  breeding  place,  although  perhaps 
the  great  majority  of  these  flies  are  born  in  horse  manure.  For  the  end  in 
view,  "typhoid  fly"  is  considered  the  best  name. 

In  1899  the  writer  began  the  study  of  the  typhoid  or  house-fly  under  both 
country  and  city  conditions.  He  made  a  rather  thorough  investigation  of  the 
insect  fauna  of  human  excrement,  and  made  a  further  investigation  of  the  species 
of  insects  that  are  attracted  to  food  supplies  in  houses.  In  a  paper  entitled  "A 
Contribution  to  the  Study  of  the  Insect  Fauna  of  Human  Excrement  (with 
special  reference  to  the  spread  of  typhoid  fever  by  flies),"  published  in  the  Pro- 
ceedings of  the  Washington  Academy  of  Sciences,  Volume  II,  pages  541-604, 
December  28,  1900,  he  showed  that  98.8  per  cent  of  the  whole  number  of  insects 
captured  in  houses  throughout  the  whole  country  under  the  conditions  indicated 
above  were  Musca  domestica,  the  typhoid  or  house-fly.  He  showed  further  that 
this  fly,  while  breeding  most  numerously  in  horse  stables,  is  also  attracted  to  hu- 
man excrement  and  will  breed  in  this  substance.  It  was  shown  that  in  towns  where 
the  box  privy  was  still  in  existence  the  house  fly  is  attracted  to  the  excrement, 
and,  further,  that  it  is  so  attracted  in  the  filthy  regions  of  a  city  where  sanitary 
supervision  is  lax  and  where  in  low  alleys  and  corners  and  in  vacant  lots  excre- 
ment is  deposited  by  dirty  people.  He  stated  that  he  had  seen  excrement  which 
had  been  deposited  overnight  in  an  alleyway  in  South  Washington  swarming 
with  flies  under  the  bright  sunlight  of  a  June  morning  (temperature  92°  F.), 
and  that  within  30  feet  of  these  deposits  were  the  open  windows  and  doors  of 
the  kitchens  of  two  houses  kept  by  poor  people,  these  two  houses  being  only 
elements  in  a  long  row.  The  following  paragraph  is  quoted  from  the  paper  just 
cited : 

34 


"Now,  when  we  consider  the  prevalence  of  typhoid  fever  and  that  viru- 
lent typhoid  bacilli  may  occur  in  the  excrement  of  an  individual  for  some  time 
before  the  disease  is  recognized  in  him,  and  that  the  same  virulent  germs  may 
be  found  in  the  excrement  for  a  long  time  after  the  apparent  recovery  of  a 
patient,  the  wonder  is  not  that  typhoid  is  so  prevalent  but  that  it  does  not  pre- 
vail to  a  much  greater  extent.  Box  privies  should  be  abolished  in  every  com- 
munity. The  depositing  of  excrement  in  the  open  within  town  or  city  limits 
should  be  considered  a  punishable  misdemeanor  in  communities  which  have 
not  already  such  regulations,  and  it  should  be  enforced  more  rigorously  in 
towns  in  which  it  is  already  a  rule.  Such  offenses  are  generally  committed  after 
dark,  and  it  is  often  difficult  or  even  impossible  to  trace  the  offender;  therefore, 
the  regulation  should  be  carried  even  further  and  require  the  first  responsible 
person  who  notices  the  deposit  to  immediately  inform  the  police,  so  that  it  may 
be  removed  or  covered  up.  Dead  animals  are  so  reported;  but  human  excrement 
is  much  more  dangerous.  Boards  of  health  in  all  communities  should  look  after 
the  proper  treatment  or  disposal  of  horse  manure,  primarily  in  order  to  reduce 
the  number  of  house-flies  to  a  minimum,  and  all  regulations  regarding  the  dis- 
posal of  garbage  and  foul  matter  should  be  made  more  stringent  and  should  be 
more  stringently  enforced." 

Even  if  the  typhoid  or  house-fly  were  a  creature  difficult  to  destroy,  the 
general  failure  on  the  part  of  communities  to  make  any  efforts  whatever  to 
reduce  its  numbers  could  properly  be  termed  criminal  neglect ;  but  since,  as  will 
be  shown,  it  is  comparatively  an  easy  matter  to  do  away  with  the  plague  of  flies, 
this  neglect  becomes  an  evidence  of  ignorance  or  of  a  carelessness  in  regard  to 
disease-producing  filth  which  to  the  informed  mind  constitutes  a  serious  blot 
on  civilized  methods  of  life. 

The  orders  of  the  health  department  of  the  District  of  Columbia,  pub- 
lished May  3,  1906,  if  carried  out  will  be  very  effective.  These  orders  may  be 
briefly  condensed  as  follows: 

All  stalls  in  which  animals  are  kept  shall  have  the  surface  of  the  ground 
covered  with  a  water-tight  floor.  Every  person  occupying  a  building  where 
domestic  animals  are  kept  shall  maintain,  in  connection  therewith,  a  bin  or  pit 
for  the  reception  of  manure,  and  pending  the  removal  from  the  premises  of  the 
manure  from  the  animal  or  animals  shall  place  such  manure  in  said  bin  or  pit. 
This  bin  shall  be  so  constructed  as  to  exclude  rain  water,  and  shall  in  all  other 
respects  be  water-tight,  except  as  it  may  be  connected  with  the  public  sewer.  It 
shall  be  provided  with  a  suitable  cover  and  constructed  so  as  to  prevent  the 
ingress  and  egress  of  flies.  No  person  owning  a  stable  shall  keep  any  manure  or 
permit  any  manure  to  be  kept  in  or  upon  any  portion  of  the  premises  other  than 
the  bin  or  pit  described,  nor  shall  he  allow  any  such  bin  or  pit  to  be  overfilled  or 
needlessly  uncovered.  Horse  manure  may  be  kept  tightly  rammed  into  well- 
covered  barrels  for  the  purpose  of  removal  in  such  barrels.  Every  person 
keeping  manure  in  any  of  the  more  densely  populated  parts  of  the  District  shall 
cause  all  such  manure  to  be  removed  from  the  premises  at  least  twice  every  week 
between  June  i  and  October  31,  and  at  least  once  every  week  between  No- 
vember I  and  May  31,  of  the  following  year.  No  person  shall  remove  or 
transport  any  manure  over  any  public  highway  in  any  of  the  more  densely 
populated  parts  of  the  District  except  in  a  tight  vehicle,  which,  if  not  in- 
closed, must  be  effectually  covered  with  canvas,  so  as  to  prevent  the  manure 


from  being  dropped.  No  person  shall  deposit  manure  removed  from  the  bins 
or  pits  within  any  of  the  more  densely  populated  parts  of  the  District  without  a 
permit  from  the  health  officer.  Any  person  violating  any  of  these  provisions 
shall,  upon  conviction  thereof,  be  punished  by  a  fine  of  not  more  than  $40  for 
each  offense. 

In  addition  to  this  excellent  ordinance,  others  have  been  issued  from 
the  health  department  of  the  District  of  Columbia  which  provide  against  the  con- 
tamination of  exposed  food  by  flies  and  by  dust.  The  ordinances  are  excellently 
worded  so  as  to  cover  all  possible  cases.  They  provide  for  the  registration  of  all 
stores,  markets,  cafes,  lunch  rooms,  or  of  any  other  place  where  food  or  bever- 
age is  manufactured  or  prepared  for  sale,  stored  for  sale,  offered  for  sale,  or 
sold,  in  order  to  facilitate  inspection,  and  still  more  recent  ordinances  provide 
for  the  registration  of  stables.  An  excellent  campaign  was  begun  during  the 
summer  of  1908  against  insanitary  lunch  rooms  and  restaurants.  A  number  of 
cases  were  prosecuted,  but  conviction  was  found  to  be  difficult. 

For  one  reason  or  another,  the  chief  reason  being  the  lack  of  a  sufficient 
force  of  inspectors  under  the  control  of  the  health  officers,  the  ordinance  in 
regard  to  stables  has  not  been  carried  out  with  that  perfection  which  the  situa- 
tion demands.  In  the  summer  of  1896,  the  health  officer  of  the  District,  Dr. 
W.  C.  Woodward,  designated  a  region  in  Washington  bounded  by  Pennsylvania 
avenue.  Sixth  street,  Fifteenth  street,  and  the  Potomac  River,  which  was  to  be 
watched  by  assistants  of  the  writer.  Twenty-four  stables  were  located  in  this 
region  and  were  visited  weekly  by  two  assistants  chosen  for  the  purpose.  The 
result  was  that  on  the  whole  the  manure  was  well  looked  after  and  the  number 
of  flies  in  the  region  in  question  was  very  considerably  reduced  during  the  time 
of  inspection. 

Were  simple  inspection  of  stables  all  that  is  needed,  a  force  of  four  in- 
spectors, specially  detailed  for  this  work,  could  cover  the  District  of  Columbia, 
examining  every  stable,  after  they  were  once  located  and  mapped,  once  a  week. 
The  average  salary  of  an  inspector  is  $1,147,  so  that  the  total  expense  for  the 
first  year  would  be  something  like  $4,500.  But  the  inspectors'  service  is  compli- 
cated by  the  matter  of  prosecution.  Much  of  the  time  of  inspectors  would  be 
taken  in  the  prosecution  of  the  owners  of  neglected  premises.  Moreover,  the 
health  officer  has  found  during  the  summer  of  1908,  in  his  prosecution  of  the 
owners  or  managers  of  insanitary  restaurants,  that  his  inspectors  were  practi- 
cally sworn  out  of  court  by  the  multiplicity  of  opposing  evidence.  This  means 
that  it  will  be  necessary  in  such  cases  to  send  two  inspectors  together  in  all 
cases,  so  that  the  testimony  of  one  may  be  supported  by  the  testimony  of  the 
other.  This,  perhaps,  would  double  the  number  of  necessary  inspectors,  making 
the  expense  of  the  service  something  over  $9,000.  It  is  reasonably  safe  to  state, 
however,  that  with  such  an  expense  for  competent  service,  or  perhaps  with  a 
slightly  added  expense,  the  typhoid  fly  could  be  largely  eliminated  as  an  element 
in  the  transfer  of  disease  in  the  District  of  Columbia,  and  the  difficulty  which  the 
authorities  have  had  in  locating  the  cause  of  a  very  considerable  proportion  of 
the  cases  of  typhoid  in  the  District  for  the  past  two  or  three  years  indicates 
plainly  to  the  mind  of  the  writer  that  the  typhoid  fly  is  a  much  more  important 
element  than  has  been  supposed.  It  is  a  comforting  although  comparatively 
insignificant  fact  and  a  matter  of  common  observation  that  in  certain  sections 
of  the  city  the  typhoid  fly  has  been  much  less  numerous  during  the  past  summer 
than  in  previous  years.  The  writer  is  inclined  to  attribute  this  to  the  gradual 
disappearance  of  horse  stables  in  such  sections,  brought  about  by  the  rapidly 
increasing  use  of  motor  vehicles. 


THE  GUILT   OF   THE  ''TYPHOID  FLY" 
SCIENTIFICALLY  ESTABLISHED 

From  the  Report  of  Dr.  Alice  Hamilton  on  the  Typhoid  Fever  Epidemic  in 
Chicago  in  July-September,   1902 

Two  places  were  selected  in  the  neighborhood  of  Hull  House  as  espe- 
cially favorable  for  such  an  examination.*  The  first  was  an  unconnected  privy 
on  Polk  street,  into  which  the  discharges  from  two  cases  of  typhoid  fever  were 
being  thrown  without  any  attempt  at  disinfection.  The  vault  was  either  very 
shallow  or  very  full,  for  the  dejecta  lay  within  three  feet  of  the  opening  and 
had  caught  on  the  projecting  scantling  within  a  foot  of  the  opening.  The  flies 
caught  within  the  vault,  on  the  fence  of  the  yard,  and  inside  the  sick-room  of 
one  of  the  patients,  which  was  also  used  as  a  kitchen,  were  dropped  into  test- 
tubes  containing  culture  medium  and  allowed  to  remain  there  for  periods  vary- 
ing from  fifteen  minutes  to  twelve  hours,  and  were  taken  to  the  laboratory  of 
the  Memorial  Institute  for  Infectious  Diseases  for  examination.  The  full  details 
of  this  part  of  the  investigation  have  been  published  in  the  "Journal  of  the  Amer- 
ican Medical  Association."  In  two  of  the  tubes,  the  one  from  the  sick-room  and 
the  one  from  the  yard,  the  typhoid  bacillus  was  discovered.  In  one  of  the  tubes 
inoculated  by  flies  from  the  vault  a  bacillus  was  discovered  closely  related  to  but 
not  identical  with  the  typhoid  bacillus,  belonging  apparently  to  the  group  inter- 
mediate between  the  typhoid  and  colon  groups.  This  is  a  group  of  bacilli  which 
have  been  isolated  from  patients  suffering  from  typhoid-like  affections. 

The  second  place  chosen  was  a  yard  on  Aberdeen  street  containing  one 
large,  full  and  filthy  vault,  not  connected  with  the  sewer.  This  is  used  by  six- 
teen families.  Flies  from  the  three  privies  built  over  this  cesspool  were  used 
to  inoculate  four  tubes.  Other  flies  from  the  fence  of  the  yard  and  from  the 
walls  of  the  two  houses  bounding  the  yard  at  varying  distances  from  the  vault 
were  dropped  into  six  tubes.  In  three  of  these  tubes  tlie  typhoid  bacillus  was 
discovered. 

At  the  time  the  collection  was  made  there  were  no  fresh  typhoid  dis- 
charges being  emptied  into  this  vault,  so  that  the  presence  of  living  typhoid 
bacilli  on  the  legs  of  the  flies  apparently  proves  either  that  the  bacilli  already  in 
the  vault  were  living  and  multiplying,  or  that  the  discharges  of  the  recovered 
cases  still  contained  typhoid  bacilli.  In  the  Polk  street  house  the  flies  caught  in 
the  sick-room  are  especially  interesting.  This  room  was  also  used  as  a  kitchen, 
and  at  the  time  the  collection  was  made  the  table  was  covered  with  food  upon 
which  could  be  seen  flies  both  living  and  dead.  The  conditions  found  at  these 
two  places  are  repeated  over  and  over  in  this  neighborhood;  and  when  one 
considers  that,  in  addition  to  the  privies  and  defective  plumbing,  there  are  the 
sewer-infected  back  yards,  that  food  is  kept  more  or  less  exposed,  not  only  in 
the  houses,  but  in  the  groceries  and  fruit-stands,  and  that  the  houses  are  not 
furnished  with  screens,  it  can  easily  be  seen  what  an  important  part  the  house- 
fly may  play  in  the  spread  of  typhoid  infection  in  such  a  neighborhood.  It  can 
also  be  seen  that  this  is  one  factor  which  does  not  come  into  play  to  such  an 
extent  in  more  well-to-do  parts  of  the  city,  where  the  screens  and  good  plumbing 

•To  sli'jw  the  »Kt,-ncy  of  Hies  in  the  di»scmin:ilion  of  typhniM  infection 

37 


are  the  rule,  or  in  newer  parts  of  the  city,  where  the  excrement  is  properly  dis- 
posed of.  It  seems,  therefore,  not  unwarranted  to  assume  that  the  contraction 
of  typhoid  fever  in  this  particular  quarter  of  the  city  during  the  late  epidemic 
was  due  to  the  spread  of  the  bacilli  by  flies  from  the  undrained  or  imperfectly 
drained  cesspools,  the  leaking  closets,  and  the  infected  earth  of  the  yards. 

When  such  conditions  as  these  exist  in  any  part  of  a  city,  they  form  a 
lasting  menace  to  the  health  of  the  community.  The  danger  is  not  over  with 
the  ending  of  warm  weather  and  the  subsidence  of  the  epidemic.  Experiments 
have  shown  that  the  urine  and  faeces  of  recovered  typhoid  patients  contain  liv- 
ing bacilli  for  many  weeks  after  every  trace  of  the  illness  is  over.  The  winter 
does  not  kill  the  bacilli:  they  have  been  found  living  in  sewage-polluted  soil 
315  days  after  they  were  planted  there,  although  in  ordinary  non-polluted  soil 
they  soon  disappear. 

HOW  TO  CHECK  THE  BREEDING    OF  FLIES 

From  a  Paper  by  Robert  Newstead,  A.  L.  S.,  F.  E.  S.,  in  the  "Annals    of 

Tropical  Medicine  and  Parasitology"  of  the  Liverpool  School  of 

Tropical  Medicine — Vol.  i,  November  4,  1908 

If  house-flies  are  to  be  reduced  to  a  minimum,  I  would  submit  the  fol- 
lowing suggestions: 

1.  That  stable  manure  and  spent  hops  should  not  be  allowed  to  accumu- 
late in  the  middensteads*  during  the  months  of  May  to  October,  inclusive,  for 
a  period  of  more  than  seven  days. 

2.  All  middensteads  should  be  thoroughly  emptied  and  carefully  swept  at 
the  period  stated  in  i. 

The  present  system  of  partly  emptying  such  receptacles  should  in  all 
cases  be  discontinued. 

The  walls  of  middensteads  should  also  be  cemented  over,  or,  failing  this, 
the  brickwork  should  be  sound  and  well  pointed. 

3.  That  all  ashpits  should  be  emptied,  during  the  summer  months,  at  in- 
tervals of  not  more  than  ten  days. 

4.  That  the  most  strenuous  efforts  should  be  made  to  prevent  children 
defecating  in  the  courts  and  passages ;  or  that  the  parents  should  be  compelled 
to  remove  such  matter  immediately;  and  defecation  in  stables  middens  should 
be  strictly  forbidden.  The  danger  lies  in  the  overwhelming  attraction  which 
such  faecal  matter  has  for  house-flies,  which  later  may  afterwards  come  into 
direct  contact  with  man  or  his  foodstuflfs.  They  may,  as  Veeder  puts  it,  "in  a 
very  few  minutes  *  *  *  load  themselves  with  dejections  from  a  typhoid  or 
dysenteric  patient,  not  as  yet  sick  enough  to  be  in  hospital  or  under  observation, 
and  carry  the  poison  so  taken  up  into  the  very  midst  of  the  food  and  water  ready 
for  use  at  the  next  meal.    There  is  no  long  roundabout  process  involved." 

5.  Ashpit  refuse,  which  in  any  way  tends  to  fermentation,  such  as  bed- 
ding, straw,  old  rags,  paper,  waste  vegetables,  dirty  bedding  from  the  hutches 
of  pet  animals,  etc.,  should,  if  possible,  be  disposed  of  by  the  tenants,  preferably 
by  incineration,  or  to  be  placed  in  a  separate  receptacle  so  that  no  fermentation 

•Manure  pitsor  limilar  receptacles. 

88 


FLY  LARV.E  AND  PUP^  IN  WASTE  PAPER  (ASH-PIT  REFUSE,  EGGS  OF  HOUSF  FT  V  trp-att  v  ,=-xTr  ,  „^x~,. 

NATURAI    St7P  E,i»us  ut   HUUbt-FLY  GREATL\   ENLARGED,  SHOWING  THE 

NATURAL  SIZE  SEGMENTS  OF  THE  LARV^  THROUGH  THE  CUTICLE 

Photographs  by  Robert  Newstead;  by  courtesy  of  the  Liverpool  School  of  Tropical  Medicine. 


BACTERIA    LEFT    HY    FLV    PASSING    OVER    (iELATINE    PLATE 
(Permission  of  Doublrday,  Page  &  Co.) 


could  take  place.  If  such  precautions  were  adopted  by  householders,  relatively 
few  house-flies  would  breed  in  the  ashpits,  and  the  present  system  of  emptying 
such  places  at  longer  intervals  than,  say,  four  to  six  weeks,  might  be  continued. 

6.  The  application  of  Paris  green  at  the  rate  of  2  ounces  to  one  gallon  of 
water  to  either  stable  manure  or  ashpit  refuse  will  destroy  99  per  cent  of  the 
larvae.  Possibly  a  smaller  percentage  of  Paris  green  might  be  employed  with 
equally  good  results. 

One  per  cent  of  crude  atoxyl  in  water  kills  100  per  cent  of  fly  larvae. 

The  application  of  either  of  these  substances  might,  however,  lead  to 
serious  complications,  and  it  is  very  doubtful  whether  they  could  be  employed 
with  safety.  Paris  green,  at  the  rate  of  i  to  2  ounces  to  20  gallons  of  water, 
is  used  largely  as  an  insecticide  for  fruit  pests.  It  does  no  harm  to  vegetation 
when  applied  in  small  quantities ;  but  cattle  might  be  tempted  to  eat  the  dirty 
straw  in  manure  which  had  been  treated  with  the  substance,  and  the  results 
might  prove  fatal  if  large  quantities  were  eaten. 

7.  The  use  of  sun-blinds  in  all  shops  containing  food  which  attracts 
flies  would,  in  my  opinion,  largely  reduce  the  number  of  flies  in  such  places 
during  hot  weather.  Small  fruiterers'  and  confectioners'  shops,  as  a  rule,  are 
not  shaded  by  sun-blinds,  and  in  their  absence  flies  literally  swarm  on  the  arti- 
cles exposed  for  sale. 

8.  The  screening  of  middensteads  with  fine  wire  gauze  would,  undoubtedly, 
prevent  flies  from  gaining  access  to  manure,  etc.,  but  it  is  very  doubtful  if  this 
method  would  meet  with  any  marked  success.  The  gauze  would  rapidly  oxidize, 
the  framework  supporting  it  would  probably  warp,  and  numbers  of  flies  would 
be  admitted  whenever  the  receptacle  was  opened.  Moreover,  the  erection  of 
such  a  structure  would  prove  a  great  inconvenience  and  a  hindrance  to  the 
removal  of  the  refuse.  This,  however,  does  not  prejudice  the  possibility  of 
erecting  a  good  fly-proof  screen  in  the  future. 


FLIES,  CONSUMPTION  AND  TYPHOID 

From  a  Paper  by  John  B.  Huber,  M.  D.,  Professor  of  Pulmonary  Diseases, 

Fordham  University  Medical  School,  Neiv  York,  in  the  "New 

York   State  Journal   of  Medicine" 

The  tubercle  bacillus  is  unquestionably  distributed  by  flies.  No  one 
can  doubt  this  who  has  seen  the  photograph  which  depicts  a  Petrie  plate  con- 
taining a  nutrient  medium  upon  which  was  deposited  a  fly  that  had  previously 
walked  in  and  had  got  the  sputum  of  a  consumptive  entangled  in  its  feet.  A 
glass  cover  confined  the  fly.  The  plate  was  at  first  perfectly  clear ;  soon  colonies, 
visible  to  the  naked  eye  and  made  up  of  uncountable  bacilli,  developed  upon  the 
track  made  by  this  fly. 

It  is  certain  that  flies  help  greatly  to  swell  the  infant  death  rate.  The 
infant  mortality  is  greatest  in  fly  time.  There  are  few  more  congenial  culture 
media  for  bacteria  than  milk,  especially  amidst  the  uncleanliness  which  obtains 
in  the  houses  of  many  very  poor  people.  This  fluid  easily  becomes  contaminated 
with  the  excreta  of  flies  and  with  the  noxious  matter  clinging  to  their  feet. 
Tuberculosis  is  thus  in  a  very  appreciable  manner  contracted  by  children,  as 

89 


also  dysenteries  and  diarrhceas.  This  is  especially  so  since  we  are  now  con- 
vinced that  all  kinds  of  diarrhoeas,  except  the  comparatively  few  cases  which 
are  induced  by  mechanical  causes,  are  due  to  specific  germs.  The  work,  which 
has  been  accomplished  by  the  authorities,  with  the  co-operation  of  medical  and 
other  beneficent  societies,  has  had  the  result  that  contamination  of  milk  by  flies, 
before  it  reaches  the  consumer,  is  probably  rare  nowadays ;  the  infection  which 
results  from  milk  through  the  agency  of  flies  becomes  possible  mostly  after 
delivery  to  the  consumer. 

Typhoid  fever  is  certainly  disseminated  by  flies,  although  there  are,  of 
course,  other  sources  of  infection.  Flies  pollute  food  and  drink  by  means  of 
the  excreta  which  they  convey  from  dung-heaps,  manure-pits,  open  closets,  and 
of  the  refuse  which  they  convey  from  rotting  vegetable  matter.  They  breed 
almost  exclusively  in  excrement.  They  certainly  disseminate  cholera;  and 
cases  of  tetanus  seem  to  have  been  originated  through  their  agency. 

THE  HOUSE-FLY  AND  ITS  CONNECTION 
WITH  DISEASE  DISSEMINATION 

From  a  Paper  in  the  Nezv    York    "Medical    Record,"    January  26,   1907,  by 
Gordon  K.  Dickinson,  M.  D.,  Surgeon,  City  Hospital,  Jersey  City,  N.  J. 

Seven  different  varieties  of  flies  are  found  in  our  houses,  98  per  cent 
of  which  is  the  common  house-fly  (Musca  domestica).  Born  in  manure,  gener- 
ally that  of  the  horse,  or  in  decomposing  matter  of  any  kind,  vegetable  as  well 
as  animal,  they  enter  our  homes  to  alight  on  foods  there  stored.  Their  tastes 
are  indelicate  and  omnivorous ;  they  subsist  on  sputum,  faecal  juices,  and  the 
slime  and  dirt  that  stick  to  exposed  surfaces.  Their  proboscides,  through 
which  they  feed,  are  connected  with  an  extremely  active  salivary  gland,  capable 
of  pouring  out  a  large  quantity  of  saliva,  which  the  fly  projects  against  a  dry 
surface,  swallowing  the  subsequent  solution.  Naturally,  solid  particles,  living 
organisms,  parasites,  and  eggs,  small  enough,  may  pass  into  this  digestive  tube. 
Bacilli  of  different  types  and  eggs  of  the  nematodes  have  been  observed  in  the 
proboscides,  stomach,  intestinal  tract  and  defecations.  The  time  that  particles 
remain  in  the  digestive  tract  of  the  fly  is  from  12  to  23  days.  Evidently  the 
digestive  secretions  are  not  active  for  harm,  as  organisms  will  not  only  pass 
through  alive,  but  increase  in  number  while  in  transit.  There  must  be  some 
absorption  of  the  toxins  of  bacilli,  for  flies  die  in  large  numbers  which  have 
had  the  fortune  to  imbibe  such  bacilli  as  those  of  the  plague  and  anthrax.  Flics 
are  large  breeders,  lay  their  eggs  by  preference  in  horse  manure,  but  also  in 
decaying  meat,  meat  broth,  cut  melons,  dead  animals,  and  even  in  cuspidors. 
On  these  substances  their  larvae  subsist  until  they  hatch.  From  10  days  to 
two  weeks  after  the  time  the  eggs  have  been  laid  the  fly  is  fully  hatched.  It  is 
estimated  that  one  fly,  laying  120  eggs  at  a  time,  will  have  a  progeny  amounting 
up  to  the  sextillions  at  the  end  of  the  season. 

Every  privy,  every  open  window,  every  dead  animal  in  the  street,  expec- 
torations of  people  suffering  or  incompletely  recovered  from  any  infectious 
disease,  the  nares  of  scarletina  patients  suffering  from  catarrh  or  acquired 
colds — in  fact,  all  conditions  where  pathogenic  bacteria  or  intestinal  parasites 

40 


OUR  FIRST  SUMMER  BOARDER      THE  ARRIVAL  OF  MADAM  FLY,  HER  CHILDREN 
AND  HER  BAGGAGE. 

By  courtesy  of  Good  Housekeeping 


^:.^- 


CONSUMPTIVE  SPITTINGohFIOOR. 

FLIES  FtEDINGON  IT, CARRY  THE 
8ERMS  OF  THE  DISEASE  TO  FOOD. 


THE  SPIT  DRIES  AND  CARELESS 
SWEEPING, DUSTING  OR  DRAUGHTS 
CAUSE  THE  GERMS  TO  FLOAT  IN  THE  AIR. 


THE  GERMS  MAY  ENTER 
THE  BODIES  OF  CHILDREN 
PUYIN6  ON  THE  FLOOR, 
THROUGH  SORES  onWOUNDS 


OTHERS  MAY  GET  THE  DISEASE  BY  BREATHIN6 
OR  SWALLOWING  THE  GERMS. 
SPRAY  GIVEN  OFF  IN  SNEEZING  OR C0U6HIN6, 
CONTAINS  GERMS  IN  A  MOIST  AND  ACTIVE  STATE. 


NEW    YORK    STATE    DEPARTMENT       OF     HEALTH. 


ONE  OK  THE  POPULAR  EDUCATIONAL  BANNERS  USED  BY  THE  NEW  YORK  STATE  DEPART.MENT  OF 
HEALTH  TO  SHOW  HOW  HOUSE-FLIES  CARRY  THE  GERMS  OF  TUBERCULOSIS 


may  openly  exist,  make  possible,  and  even  probable,  the  spread  of  disease  by 
flies.  This,  being  known,  should  be  acted  upon.  There  are  few  boards  of 
health  as  intelligent  and  far-sighted  as  that  of  Philadelphia,  which  has  taken 
vigorous  measures  to  protect  the  public  against  infection  of  food  by  flies.  In- 
spectors are  directed  to  visit  all  milk  houses,  butcher  shops,  grocery  and  candy 
stores,  and  instruct  the  owners  to  place  a  covering  over  all  articles.  The  order 
reads:  "The  chiefs  of  divisions  of  nuisances,  milk  and  meat,  and  cattle  inspec- 
tors are  hereby  instructed  to  visit  all  retail  dealers  exposing  for  sale  in  front  of 
their  properties  meats,  fish,  vegetables,  fruits,  candies,  and  cake,  and  instruct 
the  proprietors  that  a  covering  of  some  suitable  material  must  be  provided  to 
protect  the  goods  so  exposed  from  flies  and  insects  generally." 

When  mosquitoes  were  discovered  to  have  a  part  in  the  dissemination  of 
malaria  and  yellow  fever,  it  was  thought  that  a  prevention  of  their  breeding 
was  too  great  a  proposition,  yet  it  has  been  satisfactorily  accomplished,  so  that 
now  one  case  of  yellow  fever  in  all  Cuba  will  create  more  comment  in  the  daily 
papers  than  at  one  time  an  epidemic  in  Havana.  Certainly,  when  the  profes- 
sion and  the  laity  become  alive  to  the  dangers  incident  to  the  presence  of  flies, 
and  recognize  in  them  a  receptacle  and  a  carrier,  then  will  the  problem  be  at- 
tacked and  solved. 

Attached  to  all  stables  there  should  be  built  a  pit  of  sufficient  size,  closed 
tightly,  with  the  exception  of  a  ventilating  window  properly  screened,  and  so 
constructed  that  little  direct  light  may  enter.  Manure,  as  soon  as  dropped  from 
the  animal,  should  be  pushed  into  this  pit,  and  chloride  of  lime  or  crude  oil  fre- 
quently scattered  over  its  contents.  All  organic  filth,  such  as  human  manure, 
if  conditions  do  not  allow  of  a  sewerage  system,  should  be  covered  immediately 
with  sufficient  earth.  All  offal  and  organic  debris,  in  which  flies  can  lay  their 
eggs  and  propagate,  should  be  disposed  of,  secluded,  or  screened.  Hospitals, 
particularly  where  contagious  diseases  exist,  and  rooms  containing  the  same, 
should  have  all  the  windows  and  doors  carefully  screened,  and  every  effort 
made  to  rid  the  interior  of  such  flies  as  may  enter.  All  food,  particularly  milk 
and  such  articles  as  are  eaten  uncooked,  should  receive  full  attention  and  pro- 
tection. 

PROTECTION  OF  FOOD  SUPPLIES  FROM  FLIES 

Frovi  a  Paper  in"Country  Life  in  America," June,  1903,  by  William  Lyman 
Underwood,  Lecturer  in  the  Massachusetts  Institute  of  Technology 

It  is  most  important  that  flies  should  be  kept  away  from  all  food  suppNes. 

To  this  end  every  effort  should  be  made,  first,  to  do  away  with  all  places 
that  are  favorable  for  the  breeding  of  flies.  Horse  manure  should  be  kept  in  a 
closed  pit,  or  the  place  where  it  is  stored  should  be  screened.  Metal  screens 
that  will  not  rust  are  best  for  this  purpose,  but,  unfortunately,  they  are  too 
high-priced  to  permit  of  their  being  used  by  the  majority  of  people  who  live  in 
the  country.  Cotton  mosquito  netting,  however,  is  not  very  expensive,  and, 
though  it  will  not  last  as  long  as  the  rust-proof  metal  screens,  it  is  just  as  ef- 
fective in  keeping  out  the  flics.  Cotton  netting  can  generally  be  purchased  at  a 
trifle  over  three  cents  a  square  yard  when  bought  by  the  piece,  and  each  piece 
contains  sixteen  square  yards.     Where  it  is  not  practical  to  use  screens,  chlo- 

O 


ride  of  lime,  if  used  in  liberal  quantities  and  well  sprinkled  through  the  manure, 
will  prevent  the  development  of  any  eggs  which  may  be  deposited  in  the 
manure. 

In  the  second  place,  screens  or  cotton  netting  should  be  put  upon  the 
kitchen  and  dining-room  doors  and  windows,  and  a  sheet  or  two  of  sticky  fly- 
paper, which  can  be  bought  at  nearly  every  country  store,  should  be  placed  in 
all  rooms  where  food  is  prepared,  exposed,  or  eaten.  Fly-traps,  of  which  there 
are  several  varieties  upon  the  market,  are  also  of  great  use  in  destroying  those 
flies  which  sometimes,  in  spite  of  nettings,  find  their  way  into  rooms  where  the 
screen  doors  are  frequently  opened. 

Finally,  the  privy  should  be  thoroughly  screened,  or,  better  yet,  where 
possible  it  should  be  done  away  with  altogether.  In  no  way  can  the  wastes  from 
the  human  body  be  more  safely  and  easily  disposed  of  than  through  the  medium 
of  water.  Earth  closets,  where  it  is  not  practicable  to  introduce  water  for  this 
purpose,  are  coming  very  generally  into  use,  and  it  is  to  be  hoped  that  before 
many  years  the  old-fashioned  country  outhouse,  with  its  exposure  to  flies  and  its 
many  other  objectionable  features,  will  be  a  thing  of  the  past. 


ON  ONE  FLY,  6,600,000   BACTERIA 

The  following  tabulation,  with  the  accompanying  comments,  is  taken 
from  Bulletin  No.  51  (April  1908),  of  the  Agricultural  Experiment  Station  at 
Storrs,  Conn.    The  investigations  were  made  by  W.  M.  Esten  and  C.  J.  Mason: 


SOURCES  OF  BACTERIA  FROM  FLIES. 


Source 

Total 
Number 

Total 

Acid 

Bacteria 

Rapid 
Liquefy- 
ing 
Bacteria 

Slow 
Liquefy- 
ing 
Bacteria 

Bacterium 

lactis  acidi 

Group  A 

Class  1 

Coli-aerog- 

Group  A 
Class  2 

1907 
July  27 

;«]     1  fly.     Bucteriological   Lab- 
oratory. 

3,160 

260 

600 

100, 

July  27 

4]     1  fly.    Bacteriological   Lab- 
oratory. 

550 

100 

0 

0 

■ 

[c]    19  Cow  Stable  Flies. 
Average  per  fly. 

7,980,000 

220.000 

0 

20,000 

Aug.   6 

420,000 

11,600 

0 

1,000 

y]     94  Swill  Barrel  Flies. 
Average  per  fly. 

165,000,000 

8,960,000 
95,300 

0 

0 

4,320,000 

4.630,000 

Aug.  14 

1,600.000 

0 

0 

46,000 

49,300 

[,r]     144  Pig  Pen  Flies. 
Average  per  fly. 

138,000,000 

2,110,000 

100.000 

206,000 

933,000 

1.176,000 

Aug.  14 

923.000 

18,700 

700 

1,160 

6,600 

12,200 

[/]    18  Swill  Barrel  Flies. 
Average  per  fly. 

118,800,000 

40,480,000 

"0 

14,500,000 

10,480,000 

30,000,000 

Sept.  4 

6,(i00,000 

2,182.000 

0 

804,000 

682,000 

1600,000 

jf]    30  DwelliDg  House  Flies. 
Average  per  fly. 

1.425,000 

125,000 

0 

12,500 

Sept.  21 

47,680 

4,167 

0 

417 

[h]    26  Dwelling  House  Flies. 
Average  per  fly. 

22,880,000 

22,596,000 

120.000 

34,000 

Sept.  21 

880,000 

869,000 

4.60O 

1.300 

[i]     110  Dwelling  House  Flies. 
Average  per  fly. 

85,600.000 

13.670,000 

8,8-10,000 

125,000 

322,700 

124  200 

80,300 

1,100 

Aug.  20 

y]     1  Large  Blue  Bottle  Blow  Fly 

308,700 

2,200  mo 

uld  spores 

Total    average    of   414   Flies. 
Average  %  of  414  Flies. 

1,222.570 

367.300 

7,830 

73,600 

30% 

6% 

Average  per  fly  of  256  flies,  experi- 
ments [d],  [<.■]  and  [/] 

3,081,000 

765,000 

230 

268,700 

211,500 

653,800 

Average  per  ceut  of  266  flies  ©x 
periments  [rfl,  [c]  and  [/]. 

26%      1 

8% 

7% 

18% 

From  the  above  table  the  bacterial  population  of  414  flies  is  pretty  well 
represented.  The  domestic  fly  is  passing  from  a  disgusting  nuisance  and  trou- 
blesome pest  to  a  reputation  of  being  a  dangerous  enemy  to  human  health.     A 

43 


species  of  mosquito  has  been  demonstrated  to  be  the  cause  of  the  spread  of 
malaria.  Another  kind  of  mosquito  is  the  cause  of  yellow  fever,  and  now  the 
house-fly  is  considered  an  agency  in  the  distribution  of  typhoid  fever,  summer 
complaint,  cholera  infantum,  etc. 

The  numbers  of  bacteria  on  a  single  fly  may  range  all  the  way  from  550 
to  6,600,000.  Early  in  the  fly  season  the  numbers  of  bacteria  on  flies  are  com- 
paratively small,  while  later  the  numbers  are  comparatively  very  large.  The 
place  where  flies  live  also  determines  largely  the  numbers  that  they  carry.  The 
average  for  the  414  flies  was  about  one  and  one-fourth  millions  bacteria  on  each. 
It  hardly  seems  possible  for  so  small  a  bit  of  life  to  carry  so  large  a  number  of 
organisms.  The  method  of  the  experiment  was  to  catch  the  flies  from  several 
sources  by  means  of  a  sterile  fly  net,  introduce  them  into  a  sterile  bottle  and 
into  the  bottle  a  known  quantity  of  sterilized  water,  then  shake  the  bottle  to  wash 
the  bacteria  from  the  bodies,  to  simulate  the  number  of  organisms  that  would 
come  from  a  fly  in  falling  into  a  lot  of  milk.  In  experiments  "D,"  ;'E,"  and  "F" 
the  bacteria  were  analyzed  into  four  groups.  The  objectionable  class,  coli-aero- 
genes  type,  was  two  and  one-half  times  as  abundant  as  the  favorable  acid  type. 
If  these  flies  stayed  in  the  pig-pen  vicinity  there  would  be  less  objection  to  the 
flies  and  the  kinds  of  organisms  they  carry,  but  the  fly  is  a  migratory  insect  and 
it  visits  everything  "under  the  sun."  It  is  almost  impossible  to  keep  it  out  of 
our  kitchens,  dining-rooms,  cow  stables  and  milk-rooms.  The  only  remedy  for 
this  rather  serious  condition  of  things  is,  remove  the  pig-pen  as  far  as  possible 
from  the  dairy  and  dwelling  house.  Extreme  care  should  be  taken  in  keeping 
flies  out  of  the  cow  stable,  milk-rooms,  and  dwellings.  Flies  walk  over  our 
food  and  are  the  cause  of  one  of  the  worst  contaminations  that  could  occur 
from  the  standpoint  of  cleanliness  and  the  danger  of  distributing  disease  germs. 


HOW  FLIES  CARRY  TYPHOID  GERMS 

From  a  Paper  by  Mark  A.  Brown,  M.  D.,  Health  Officer  of  Cincinnati.  0. 

Unless  the  most  stringent  measures  are  immediately  taken  for  the  proper 
disinfection  of  these  [typhoid]  discharges  tliey  become  almost  at  once  the  haven 
for  innumerable  flies,  the  bodies  of  which  harbor  innumerable  typhoid  germs. 
The  alternate  visitations  of  the  common  house-fly  from  the  latrine,  trench  or 
privy,  Ills  natural  habitation,  to  the  kitchen  and  dining-room,  afford  most  ample 
opportunity  for  the  infection  of  our  food  and  drink,  particularly  of  milk.  This 
illustration  is  by  no  means  fanciful  or  far-fetched.  The  commission  appointed 
by  the  Government  to  investigate  the  typhoid  epidemic  which  occurred  among 
our  soldiers  during  the  Spanish-American  War,  of  which  commission  Vaughan, 
of  Ann  Arbor,  was  chairman,  reported  that  infection  of  food  supplies  by  means 
of  flies  was  probably  of  even  more  importance  than  the  infection  of  drinking 
water.  It  is  a  noticeable  fact  that  while  officers  and  men  drank  the  same  water, 
typhoid  fever  was  comparatively  much  less  among  the  former,  as  all  unknow- 
ingly the  food  supplies  of  the  officers  were  much  better  protected  from  access  of 
flies.  It  would  hardly  seem  necessary  to  demonstrate  experimentally  that  flies 
and  other  insects  passively  carry  bacteria ;  nevertheless  numerous  carefully  con- 
trolled experiments  have  been  made  with  this  end  in  view,  and  successfully. 

43 


TYPES    OF    FLY    POSTERS 


RULES  FOR  DEALING  WITH  THE  FLY  NUISANCE 


KEEP  THE  FLIES  AWAY  FROM  THE  SICK,  ESPECIALLY  THOSE 
ILL  WITH  CONTAGIOUS  DISEASES.  KILL  EVERY  FLY  THAT 
STRAYS  INTO  THE  SICK  ROOM.  HIS  BODY  IS  COVERED  WITH 
DISEASE   GERMS. 

DO  NOT  ALLOW  DECAYING  MATERIAL  OF  ANY  SORT  TO 
ACCUMULATE   ON   OR    NEAR   YOUR    PREMISES. 

ALL  REFUSE  WHICH  TENDS  IN  ANY  WAY  TO  FERMENTATION, 
SUCH  AS  BEDDING  STRAW,  PAPER  WASTE  AND  VEGETABLE 
MATTER  SHOULD  BE  DISPOSED  OF  OR  COVERED  WITH  LIME 
OR   KEROSENE   OIL. 

SCREEN   ALL   FOOD. 

KEEP  ALL  RECEPTACLES  FOR  GARBAGE  CAREFULLY  COV- 
ERED AND  THE  CANS  CLEANED  OR  SPRINKLED  WITH  OIL  OR 
LIME. 

KEEP  ALL  STABLE  MANURE  IN  VAULT  OR  PIT,  SCREENED 
OR  SPRINKLED  WITH  LIME,  OIL  OR  OTHER  CHEAP  PREPARA- 
TION. 

SEE  THAT  YOUR  SEWAGE  SYSTEM  IS  IN  GOOD  ORDER  ; 
THAT  IT  DOES  NOT  LEAK,  IS  UP  TO  DATE  AND  NOT  EXPOSED 
TO    FLIES. 

POUR    KEROSENE    INTO  THE   DRAINS. 

COVER  FOOD  AFTER  A  MEAL;  BURN  OR  BURY  ALL  TABLE 
REFUSE. 

SCREEN   ALL   FOOD    EXPOSED   FOR   SALE. 

SCREEN  ALL  WINDOWS  AND  DOORS,  ESPECIALLY  THE 
KITCHEN  AND   DINING  ROOM. 

BURN  PYRETHRUM  POWDER  IN  THE  HOUSE  TO  KILL  THE 
FLIES. 

DON'T  FORGET  IF  YOU  SEE  FLIES,  THEIR  BREEDING  PLACE 
IS  IN  NEARBY  FILTH.  IT  MAY  BE  BEHIND  THE  DOOR,  UNDER 
THE  TABLE   OR    IN   THE   CUSPIDOR. 

IF  THERE  IS  NO  DIRT  AND  FILTH  THERE  WILL  BE  NO  FLIES. 

IF  THERE  IS  A  NUISANCE  IN  THE  NEIGHBORHOOD  WRITE 
AT  ONCE  TO  THE   HEALTH   DEPARTMENT. 

ISSUED     BY 

The  Merchants'  Association's  Committee  on  Pollution  of 
the  Waters  of  New  York 

EDWARD  HATCH,  Jr.,  Chairman 
J.  PIERPONT  MORGAN  JOHN  Y.  CULVER,  C.  E. 

JULY»  ie08.        ALBERT  VANDER  VEER,  H.  D.  DANIEL  D.  JACKSON 


FLY  RULES  OF  THE  CHICAGO  DEPARTMENT 
OF  HEALTH 

Screen  all  food  and  keep  flies  away  from  it. 

Keep  the  streets  clean. 

Keep  stable  manure — breeding  place  for  flies — in  a  vault  or  pit  or 
screened  inclosure  and  sprinkle  its  surface  with  chloride  of  lime. 

Quickly  cover  up  food  after  a  meal  and  bury  or  burn  table  refuse. 

Keep  damp  cloths  near  meat  dishes,  milk  jugs,  and  other  food  receptacles. 

Burn  pyrethrum  powder  in  the  house.  It  will  kill  most  of  the  flies  and 
those  it  does  not  will  fall  stunned,  when  they  may  be  swept  up  and  burned. 
Sticky  fly-papers  are  a  second-rate  palliative. 

Remember  that  the  exposure  of  any  kind  of  refuse  near  a  dwelling 
furnishes  a  breeding  place  for  flies,  and  if  food  is  exposed  the  flies  will  deposit 
germs  upon  it. 

HEALTH   DEPARTMENT  BULLETIN 
BEWARE  OF    FLIES 

The  common  house-fly  is  a  carrier  of  disease.  Typhoid  fever,  diarrhoea, 
dysentery  and  tuberculosis  are  carried  by  flies. 

No  longer  do  we  consider  flies  as  merely  annoying,  but  we  recognize  in 
them  a  very  important  factor  in  the  spread  of  certain  diseases,  particularly  those 
mentioned  above. 

Flies  Are  Filthy. — The  house-fly  is  particularly  filthy,  because  it  has 
its  birth-place  and  lays  its  eggs  almost  exclusively  in  horse  manure. 

Flies  feed  on  food  and  also  on  the  worst  kind  of  filth.  They  go  from  one 
to  the  other.  It  is  easy  to  understand  how  they  carry  disease  germs  to  ou» 
food  in  this  manner. 

Our  domestic  animals,  the  dog  and  cat,  though  far  from  clean  in  all  dieir 
habits,  we  like  to  have  about  us,  but  we  keep  them  in  their  proper  place.  The 
house-fly,  on  the  other  hand,  is  tolerated  everywhere,  crawls  over  our  hands  and 
faces,  gets  into  the  milk,  walks  over  all  our  food,  often  soiling  and  contaminating 
everything  that  comes  in  contact  with  its  filthy  feet  and  tongue. 

FuES  Also  Feed  on  Sputum. — Who  has  not  seen  flies  feeding  on 
sputum  on  our  pavements  and  streets?  And,  as  there  are  people  who  have  con- 
sumption, continually  spitting  on  the  public  pavements,  is  it  not  simple  to  see  how 
the  germ  of  the  disease  can  be  taken  up  by  the  fly,  carried  away,  and  perhaps  de- 
posited in  our  homes? 

It  is  particularly  essential  that  flies  be  kept  away  from  everything  that 
infants  and  very  young  children  come  in  contact  with,  particularly  all  feeding 
utensils  and  things  that  children  are  likely  to  put  in  their  mouths. 

How  can  we  combat  this  dangerous  nuisance? 

The  essential  thing  is  to  do  away  with  the  breeding  places  of  these  dirty 
pests. 

It  may  be  said  that  flies  will  breed  in  any  decomposing  animal  or  veg- 
etable matter.    The  most  common  places  are  manure,  uncleaned  stables,  privies, 

a 


and  in  and  about  cans  and  receptacles  used  for  the  storage  of  garbage. 

Every  householder,  in  self  defense,  should  destroy  the  breeding  places 
of  these  pests. 

Store  2;arbage  in  tightly  covered  cans,  kept  in  a  screened  inclosure,  so 
that  flies  cannot  get  to  it ;  see  that  it  is  removed  very  frequently  during  the  sum- 
mer months.    Wash  and  disinfect  cans  frequently. 

Store  manure  so  that  flies  cannot  get  at  it  to  lay  their  eggs,  and  have  it 
removed  once  a  week. 

All  persons  selling  food  of  any  description  should  see  that  the  goods  are 
protected  from  flies,  and  should  not  expose  food  in  front  of  their  stores  where 
it  can  be  contaminated  by  both  flies  and  street  dust. 

Do  not  allow  decaying  matter  of  any  kind  to  accumulate  on  your  premises. 

Screen  the  doors  and  windows  of  your  house,  particularly  the  kitchen,  in 
order  to  keep  the  flies  from  entering  and  getting  on  the  food. 

Remember  that  the  female  fly  lays  about  one  hundred  and  twenty  eggs, 
which  in  the  course  of  a  few  hours  become  maggots,  and  after  another  transfor- 
mation the  full  grown  fly  appears  at  the  end  of  ten  days. 

As  in  most  matters  of  sanitation  and  hygiene,  cleanliness  is  the  watch- 
word.   Cleanliness  about  your  house  and  property  will  prevent  flies  breeding. 

Board  of  Health, 

Orange,  N,  J. 


BEWARE    OF    FLIES* 

Flies  are  filthy  insects.  They  drink  from  the  cesspools  and  dine  in  the 
privy  vaults.  They  eat  the  sputum  on  the  sidewalk,  and  revel  in  the  garbage 
pail.  They  swarm  on  the  baby's  diaper,  a  -d  are  greedy  for  the  dressings  from 
a  discharging  wound. 

Perhaps  you  think  it  is  disgusting  to  read  about  such  things,  and  so  it  is. 
But  is  it  not  more  disgusting  to  have  these  same  flies,  after  their  repast  of  filth, 
drown  in  the  milk  pitcher,  drop  their  specks  on  the  frosted  cake,  or  clean  their 
feet  on  the  bread?  Is  it  pleasant  to  see  the  flies  that  very  likely  have  just  come 
from  a  neighboring  privy  crawl  over  the  lips  of  the  sleeping  baby,  or  gather  on 
the  nipple  of  its  nursing  bottle?  Suppose  the  fly  that  was  fished  out  of  the  milk 
pitcher  had  just  been  eating  the  excrement  of  a  typhoid  fever  patient,  would  you 
like  to  drink  the  milk?  Perhaps  the  flies  that  are  walking  on  the  fruit  which 
you  purchased  at  the  street  corner  had  just  been  feedine-  on  the  sputum  of  a 
consumptive.  Does  it  not  seem  likely  that  flies  may  spr  -^  disease?  That  is 
what  many  physicians  and  health  officers  think. 

Perhaps  hereafter  you  will  screen  the  house,  and  protect  the  food  from 
flies. 

The  young  of  flies  are  maggots.  They  seem  to  prefer  t  hreed  in  stable 
manure.     But  they  also  breed  in  excrement  of  all  kinds,  in  garL  "id  in  all 

sorts  of  wet  and  filthy  refuse. 

Do  you  want  to  raise  these  filthy  insects,  these  germ-carriers,  these  indi- 

•This  circular,  written  by  Dr.  C.  V.  Chapin,  Health   Officer  of   Providence,  R.  I.  is  in  use  in   that   city 
and  is  recommended  by  the  Massachusetts  Association  of  Health  Boards. 

46 


From  FLIES  and  FILTH 
to  FOOD  and  FEVER 


*    ^    V; 


41*     ^8 


<^, 


77?^  State  Board  of  Health 
of  Florida 

ASKS  YOU  to  carefully  and  attentively  read  this  card; 
THEN,  put  the  question  directly  to  yourself,  whether 
flies  should  not  be  destroyed,  or,  at  ieast,  an  effort  be 
made  to  keep  from  polluting  food  prepared  for  you  to  eat. 

T/ies  are  disease  carriers 

Liive  and  breed  in  all  kinds  of  filth 

I  nfect  food  and  drink  by  germ-laden  feet 

Y^ach  female  fly  can  lay  150  eggs 

Should  be  kept  out  of  dwellings 


Flics  breed  In  tiors' 


irbagc  of  all  description,  dead 


Look  daily  aflcr  the  garbage  i 


and  when  removed,  cove 


of  flics  contain  live  lubcrclc  baccilli  after  ibcy  have  eaten  tuberculous  sputum, showing  that  ll: 

s  (probosces)  and  on  their  legs,  putrifying  and 

,  and  then  crawl  o       

cspcciaUy  those  ill 
crecncd  the  padcnt  should  be  I 


Flies  crawl  over  Iruits  when  exposed  for  sale,  unguarded  by  screens,  and  the  generality  of 
people  do  not  wash  fruit  before  eating  it.  This  is  a  fniilful  source  of  human  inCcction,  partic- 
ularly if  a  case  of  typhoid  lever  nearby  is  being  carelessly  handled. 

Don't  forget  that  flics  will  carry  the  bacilli  of  typhoid  (ever  from  the  stools  ol  the  patient  (if 


openings  of  the  home,  especially  the  kitchen 

Uok  ot  the  marginal  illustrations.  They  arc  disgusting,  it  is  Inic.  Soarcllies.  Tlic  disgust 
that  your  stomach  receives  through  your  eye  is  as  nothing,  however,  to  the  probable  and  pos- 
sible benefit  which  you  will  receive  by  giving  due  heed  to  the  warnings  suggested  by  the  etchings. 

STATE  BOARD  of  HEALTH 

E.  M.  HENDRY,  Prendmt 


JOSEPH  Y.  PORTER,  M.  D. 


/ifi 


cators  of  untidiness,  to  be  a  pest  in  our  own  house,  and  perhaps  carry  disease 
to  your  neighbors?    Of  course  you  do  not. 

Then  keep  the  stable  manure  closely  covered  and  have  it  removed  often 
— once  a  week  in  summer,  if  possible.  Keep  the  back  yard  and  the  alley  clean. 
Allow  no  refuse  to  accumulate  anywhere.  Connect  with  the  sewer  if  there  is 
one  in  the  street.  Fix  the  privy  so  it  will  be  fly-proof.  After  your  own  premises 
are  in  order  talk  over  the  matter  with  your  neighbors,  and  get  them  also  to 
read  this  circular. 


BIBLIOGRAPHY 

On  the  Habits,  Life-Cycle  and  Breeding  Places  of  the  Common  House-Fly — by 
Robert  Newstead,  A.  L.  S.,  F.  E.  S.  (Annals  of  Tropical  Medicine  and 
Parasitology  of  the  Liverpool  School  of  Tropical  Medicine;  Vol.  L,  No.  4; 
February,  1908. 

Typhoid  Fever:  The  Story  of  the  Fly  That  Doesn't  Wipe  Its  Feet — ^by  Woods 
Hutchinson,  A.  M.,  M.  D.  (Reprinted  by  the  Merchants'  Association  of 
New  York  from  The  Saturday  Evening  Post;  1908.) 

TTie  House-Fly  and  Its  Connection  With  Disease  Dissemination — by  Gordon  K. 
Dickinson,  M.  D.     (Published  by  William  Wood  &  Co.,  New  York;  1907.) 

The  House-Fly  as  a  Carrier  of  Disease — by  William  Lyman  Underwood,  lec- 
turer in  the  Massachusetts  Institute  of  Technology.  (Enlarged  and  ex- 
panded by  the  author  from  his  article  in  Country  Life  in  America;  1903.) 

Pollution  of  New  York  Harbor  as  a  Menace  to  Health  by  the  Dissemination  of 
Intestinal  Diseases  Through  the  Agency  of  the  Common  House-Fly — a  re- 
port by  Daniel  D.  Jackson,  S.  B.,  to  the  Water  Pollution  Committee  of  the 
Merchants'  Association  of  New  York;  1908. 

Report  on  the  spread  of  typhoid  fever  in  the  United  States  military  camps  dur- 
ing the  Spanish- American  War  of  1898,  by  Drs.  Walter  Reed,  Victor  C. 
Vaughan  and  Edward  O.  Shakespeare;  1905. 

Insects  and  Disease — ^by  John  B.  Huber,  M.  D.,  Professor  of  Pulmonary 
Diseases,  Fordham  University  Medical  School,  New  York,  in  New  York 
State  Journal  of  Medicine,  November  1908. 

Report  of  the  Health  Officer  of  the  District  of  Columbia — by  George  M.  Kober, 
M.  D.,  Washington;  1895. 

Typhoid  Fever  in  the  Army — Editorial  in  Engineering  News  (New  York), 
September  22,  1898. 

The  Role  of  Insects  in  the  Spread  of  Disease — by  George  H.  P.  Nuttall,  M.  D., 
(Johns  Hopkins  Hospital  Reports;  Vol.  VIII.,  1898.) 

A  Contribution  to  the  Study  of  the  Insect  Fauna  of  Human  Excrement — by 
L.  O.  Howard,  Ph.  D.,  Chief  of  the  Bureau  of  Entomology,  Department  of 
Agriculture.     (Published  by  the  Washington  Academy  of  Sciences;  1900.) 

47 


House- yiics — Burean   of   Entomology   Circular   No.   71    (revised   edition) — ^by 
L.  O.  Howard. 

How  Insects  Affect  the  Health  in  Rural  Districts — U.  S.  Department  of  Agri- 
culture, Farmers'  Bulletin  No.  155— by  L.  O.  Howard. 
The  House-Fly — Monthly  Bulletin  of  Indiana  State  Board  of  Health,  May,  1908. 

The  House-Fly  Nuisance — by  W.  Frost  and  C.  T.  Vorhees,  Country  Life  in 

America,  May,  1908. 
Fighting  the  House-Fly — by  E.  V.  Wilcox,  Country  Life  in  America,  May,  1908. 
House-Flies — article  in  Florida  Health  Notes,  May,  1908. 
The  House-Fly  as  an  Agent  in  the  Dissemination  of  Infectious  Diseases — ^by 

Theobald  Smith,  M.  D.,  American  Journal  of  Public  Hygiene,  August,  1908. 

Flies  as  Spreaders  of  Disease  in  Camps — by  H.  A.  Veeder,  M.  D.,  New  York 
Medical  Record,  September,  1898. 


CORRESPONDENCE    INVITED 

Readers  of  this  pamphlet,  especially  physicians  and  others  having  to  do 
with  the  protection  of  the  health  of  the  public,  are  requested  to  communicate 
with  the  chairman  of  this  committee  any  observations  bearing  upon  the  prob- 
lems associated  with  the  fly  nuisance.  Address  the  Chairman,  Water  Polluticm 
Committee,  Merchants'  Association,  66  Lafayette  street.  New  York. 


NOTE. — Newspapers  and  periodicals  desirous  of  reprinting  the  matter 
contained  in  this  pamphlet  are  at  liberty  to  do  so,  either  with  or  without  credit 
to  the  Merchants'  Association. 


48 


Date  Due 

^ 

t)V  2  3  IS- 

IS 

^ 

Merchants'  association  of  15ew  York 
__TheJoa8e-fly  at  the  bar 


